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Public Startup : How America's Least Likely Government Program Became Its Boldest - Christopher R. Cogle

Public Startup

How America's Least Likely Government Program Became Its Boldest

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Published: 16th September 2026

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AN AMAZON BESTSELLER IN PUBLIC AFFAIRS & ADMINISTRATION

AN INGRAMSPARK BESTSELLER IN HEALTH POLICY

Why do some ideas transform entire systems while others never spread?

We celebrate startups for changing the world. We rarely ask how innovation happens inside government. Yet some of America's most influential healthcare innovations did not begin in Silicon Valley. They began inside Medicaid.

In Public Startup, physician, professor, and public health leader Christopher R. Cogle takes readers behind the scenes of one of America's most misunderstood institutions to reveal how meaningful change actually happens.

Through compelling patient stories, political battles, historical turning points, and firsthand accounts from inside medicine, entrepreneurship, academia, and state government, he uncovers the surprising forces that allow new ideas to take root and improve millions of lives.

Along the way, Cogle introduces three powerful ideas that challenge conventional thinking:

* The Margins Lead the Middle. Solutions developed for society's most vulnerable often become the standard for everyone.
* Bureaucrats Take the Risks. Many of the boldest experiments in healthcare happen quietly inside government.
* The Safety Net Is a Ladder. The strongest public programs create opportunity, restore independence, and strengthen entire communities.

Hopeful, provocative, and deeply human, Public Startup reveals that innovation is not confined to startups or private industry. Sometimes the ideas that change the world emerge from the institutions we least expect. Whether you're a healthcare professional, policymaker, entrepreneur, public servant, or simply curious about how real change happens, Public Startup will change the way you think about innovation and where to find it.

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