Public Startup is a work of narrative nonfiction that explores how American government, particularly Medicaid, can function as a platform for innovation rather than an obstacle to progress. Drawing on firsthand experience inside state government, academic medicine, startup companies, and public health, Christopher R. Cogle, M.D., examines how durable policy change actually happens through incentives, relationships, and pragmatic experimentation. Blending policy history, real-world case studies, and patient stories, the book offers a hopeful, insider's account of how public institutions can be designed to solve complex problems and improve lives in a politically divided era.