A German founder’s case for why America still needs immigrants

Florian Otto is CEO and cofounder of Cedar, a healthcare technology company that helps hospitals and doctors make medical bills easier for patients to understand, manage, and pay.

I did not grow up in a country that leaves much to chance. Germany, where I was born and raised, is a place that prizes precision, process, and getting things right the first time. It builds extraordinary engineering, and its industries are proof that rigor produces real innovation. However, building a new company from scratch is a different kind of bet than perfecting an existing one, and that’s where the instincts diverge.

When I first shared the idea that would become Cedar, an idea for fixing how patients experience medical billing, the reaction in the U.S. was telling. People acknowledged the problem was real and told me I could probably build something better. Knowing the instincts of the system I grew up in, I suspect a German audience would have reacted differently because the risk calculus for a founder is different: more scrutiny on why an existing system, developed over decades, might already have good reasons behind it, and more caution before betting on something unproven. That difference—encouragement over caution, opportunity over risk — is not a minor cultural quirk. It is the actual engine of American economic dominance, and sustaining that engine depends on three things working together: the people willing to take the bet, the policy that lets them stay long enough to see it through, and a regulatory environment clear enough that betting on hard, regulated industries still makes sense.

Start with the people. Immigrants aren’t marginal contributions to a system built by others; they are the system. Immigrants have founded or co-founded 59% of America’s privately held billion-dollar startups this year, up from 55% just a few years earlier. Nearly 80% of America’s unicorn companies........

© Fortune