Healthcare innovation still loves elegant stories. Unfortunately, elegant stories don’t get funded when budgets are constrained. For years, the industry has relied on value narratives that sound reasonable but collapse under scrutiny. The most common failure is distance in the value chain. They often sound like: “If imaging quality improves, outcomes improve. If outcomes improve, costs go down.” Each step may be directionally true, but between the first link and the last sit dozens of confounding variables, including physician behavior, care pathways, payer policy, patient compliance, downstream utilization, and time. When value depends on all of them lining up, it is not value; it is a wish.