Reader Reviews

  • "Public Startup is the clearest explanation of what Medicaid does and how it works that I have ever seen.

    Chris Cogle shows us that medicaid is not a bureaucratic nightmare that should be scrapped, but an amazing, living framework that should appeal to all politicians across the spectrum who want to improve the health of their constituents.  Its most important lesson for all of us is that "a healthier tomorrow is built not by giving up on imperfect systems, but by caring enough to improve them."  And Chris Cogle cares.  Still, caring is not enough; these times demand action. This book will inspire all who read it to care enough and get to work on improvement.”

    - Mark L. Rosenberg, MD, MPP, Founding Director, US National Center for Injury Prevention and Control

  • “Chris Cogle has written an ode to Medicaid; that complicated, sprawling, and vital program that provides health security to over one in five Americans.

    In 22 brisk chapters, he sings the many virtues of his beloved program in verse that is at once authoritative, wry and passionate, borne of his experience with the program as a teacher, researcher, clinician and agency leader. Medicaid, Cogle demonstrates, is neither broken nor bloated, as detractors claim. Rather it is scrappy, endlessly inventive and usually very effective in maximizing the value of government expenditures to maintain and improve people’s health. The reader is left wiser and more appreciative of the ability of the program and the people who run it in each state to adapt, innovate and meet the needs of the people they serve, in ways that often blaze trails for their better-financed commercial insurance colleagues.”

    - Christopher F. Koller, former President, Millbank Memorial Fund

  • “Our current public health system remains chronically under funded, while we grossly underuse tools like Medicaid that could bring financial and logistical support.

    I am convinced most in public health are not aware of the unrealized potential of Medicaid to unlock new approaches to solve old problems. Dr. Cogle's book should be required reading for both public health educators and practitioners.”

    - Claude Earl Fox, MD, MPH, former Alabama State Health Officer

  • "In this important new book, Chris Cogle reveals that powerful levers to improve the health of millions of Americans lie hidden in dense Medicaid regulations.

    In swashbuckling prose, he shows how state Medicaid leaders wield contract clauses and moral clarity to turn fiscal and legislative constraints into innovative health policy that can benefit everyone--not just decision makers. Well worth reading."

    - Jeff Brosco, MD, PhD, Clinical Professor, University of Miami Miller School of Medicine; Director for the Division of Services for Children with Special Health Needs in the Maternal and Child Health Bureau within the Health Resources and Services Administration 

Reader Reviews

Discover what readers and colleagues are saying about Dr. Cogle’s work. From thought leadership insights to reflections on his latest book, these reviews highlight the impact of his ideas on health, innovation, and public service. Explore firsthand perspectives from those inspired by his research, writing, and leadership.

About Public Startup

In Public Startup, physician-scientist Christopher R. Cogle reveals how a government program long dismissed as red tape and welfare became the nation’s most prolific innovation lab—quietly iterating on the very ideas Silicon Valley claims as its own, all while serving everyone in need.

Drawing from patient stories, heated policy battles, and first-person experience with the modern healthcare and policy systems, Public Startup reframes Medicaid not as a cost problem, but as a system of radical reinvention—one that now shapes care for nearly 1 in 4 Americans.

The book covers essential themes in health policy innovation, including:

  • Social Capital: Investments in improving social conditions pay off

  • Building Trust: Trusting patients works better than policing them

  • The Public Paradox: The safety net becomes the innovator

  • Innovation Under Constraint: Scarcity fuels invention

  • The Margins Lead the Middle: Ideas tested on the outskirts become mainstream

  • Bureaucrats as Entrepreneurs: Public servants take risks like startup founders

This innovative look at a seemingly familiar program shows how public institutions improve lives and will inspire readers to take action in shaping the policies that affect them most.