In trying to understand the current shift in economic and political winds, I thought it would be helpful to take a new look at a classic depiction of the US capitalist system, as portrayed in one of American fiction’s great works. In Ayn Rand’s Atlas Shrugged, protagonist John Galt is the leader of a small group (think top 1% of earners) of early 20th-century entrepreneurs who essentially decide to drop out of a society that is overtaken by bureaucrats, regulators, and an ethos of mediocrity. It is a definitive work that is quintessentially American in its point of view, although rather extreme in its thesis. Nevertheless, there are lessons to be learned here for all of us in the medical imaging profession. You can imagine the ensuing chaos and destruction to the fictional United States when the novel’s brain-trust members—who envisioned and built the railroads, factories, engines, bridges, airplanes, steel mills, and so on—decide that they have had enough. They, who were the innovators, creators, designers, engineers, and risk takers, built the country’s infrastructure in the same way that the present age’s Internet, computer, communications, and medical-technology innovators have. Imagine what would happen if today’s gifted Americans decided that the future looked too bleak, that the regulatory environment was too cumbersome, that the tax structure was too punitive, and that the benefit and cost of their innovations would not be worth the risk. The picture is not a pretty one. Our incredible country has achieved greatness because risk takers defied odds and dared to move against the grain of conventional wisdom, and because to strive to be in the top 1% is the ultimate American dream. The journey itself is the thrill. Somewhere between Ayn Rand’s libertarian view of society and the government-as-manager-of-everything view lies a balance that has always sustained our macroeconomic structures and our political systems—federal, state, and local. It is not an easy balance to maintain, especially given the highly charged rhetoric at the margins of each extreme. Given the realities of the current economic downturn, it is going to be even more difficult to keep a cool head and avoid falling victim to extreme points of view. I started thinking about how all of this relates to medical imaging after a recent conversation with a top executive of a large outpatient imaging organization. In the course of a discussion of the pending new CMS rules, the increasing reliance on radiology benefit managers to manage utilization, and other large bureaucratic interventions, he said something like, “Sometimes, I wish that the government would just get out of our way.” The culmination of Atlas Shrugged character Galt’s soliloquy defining the essence of the novel’s message was his climactic response to a government that was begging him to become dictator: “Just get out of my way.” Prescient. I am not a libertarian, and of course, I know that we need our various forms of government. I am no fan, either, of those mediocre multimillionaires who took great companies (that they did not create) and systematically ran them straight into the ground while cashing their annual bonus checks. They are not entrepreneurs. They are not innovators. Frankly, most of them don’t deserve a second chance at failure using taxpayers dollars. My view is that rather than look for demons in the ranks of entrepreneurs and those businesses actually creating jobs, we need to celebrate the prudent risk takers and find ways to help them build their businesses, most of which are small enterprises. They know, instinctively, that competition makes them better, and that if allowed to operate unencumbered by overregulation, they could create sustainable growth and benefit. They are not the ones destroying. They are creating. The essential question is this: What is going to fix our economy, our health care system, and our medical imaging segment? It is, in a word, innovation. Every day, I talk to innovators looking for new ways to build value into their customer offerings. I see hardworking, entrepreneurial radiologists taking risks to meet the growing demand for imaging services. I see imaging center executives looking for ways to make themselves and their staffs more productive, more customer focused, and more accountable to those who depend on their services, and I see hospital executives trying to redefine the delivery of care upward. Likewise, technology developers and research-and-development engineers are looking for the next thing that will continue imaging’s rise to the top of health care’s disease-management arsenal. These innovators and entrepreneurs are the ones who will guide us out of this morass, just as they did in the early part of the 20th century, and just as they did in the early days of computers and the Internet. We need to celebrate the risk takers, the leaders, and those who seek ways to rise above the daily, relentless grind of bureaucracy and inefficiency to find new ways of doing things that add value. There are many innovators within the ranks of medical imaging practices around the country, and they know how to visualize and create sustainable businesses. The bureaucrats just need to get out of the way—if only a little bit.