Wisconsin has a rich history of entrepreneurial activity, which is often not appreciated beyond its well-recognized strength in the beer and cheese industries. However, Wisconsin’s entrepreneurial nature has been called into question. Recently, Wisconsin was ranked fiftieth in the United States for startup activity by the Kauffman Foundation. In contrast, Wisconsin ranks at the top of the country for startups that are local and established business with more longevity. The first half of this article will review some of the challenges and opportunities that have faced Wisconsin entrepreneurs, and will provide an overview of over 150 Wisconsin companies (Table 1), with lessons learned from the entrepreneurial journeys taken by their founders. Multiple industry sectors will be reviewed, including food and beverage, manufacturing, biotechnology and healthcare. Resources (legal, regulatory, mentoring, seed funds) that are being created to improve Wisconsin’s entrepreneurial ecosystem will also be presented.

The second half of the article will provide a deeper and forward-looking analysis of one industry sector, HealthTech (Table 2), which has significant growth potential, and potential to positively impact healthcare reform. However, the HealthTech industry also faces political, legal, regulatory, and business challenges that could block its growth—a growth that has potential to positively impact the healthcare industry. The history of the healthcare and HealthTech industry in Wisconsin will be reviewed, followed by a summary of the current status and a look forward for the industry. The status of healthcare in the United States, with its high cost and poor access, will be discussed in the context of the current political debate. It will be argued that this political debate is focused more on who is covered than on how to constrain cost and increase quality, and it does not provide a useful discussion of the relative value (and current implementation) of single payer versus competitive markets as a way to control cost and increase quality. A case will be presented that Wisconsin’s HealthTech entrepreneurs could provide lower cost and higher quality healthcare, via technology-enabled consumerization of care. Still, challenges exist that relate to privacy issues and barriers to market entry, which may extend beyond intellectual property-based monopoly-power (intended to foster innovation) into the realm of anti-competitive business practices that hinder market-driven improvements in healthcare delivery (e.g., consumer-driven value-based shopping; usage of medical centers of excellence; consumercentric integrated care). The promise of HealthTech-based consumerization tools that empower and educate consumers at the front-line of healthcare to provide higher quality care at lower cost is presented, along with the legal and regulatory challenges that may need to be addressed for HealthTech entrepreneurs to succeed in this goal.