Peter Kowey, MD, on Healthcare’s Real Crisis
Here is the uncomfortable truth: American healthcare has become astonishingly good at generating revenue — and increasingly bad at making people feel cared for.
We can sequence genomes, replace valves, ablate arrhythmias, image the body in exquisite detail, and prescribe medications our predecessors could scarcely imagine. And still, patients routinely leave encounters feeling rushed, confused, over-tested, over-medicated, denied, billed, routed, transferred, and thoroughly unheard.
Clinicians are not doing much better. They are drowning in inboxes, precertifications, malpractice anxiety, staffing shortages, corporate dashboards, and the slow corrosion of moral injury. The tragedy is that patients and physicians are not enemies. They are often co-victims of the same machine.
That is why my conversation with cardiologist, educator, researcher, and author Dr. Peter Kowey matters. His book, Failure to Treat: How a Broken Healthcare System Puts Patients and Providers at Risk, is not another polite complaint about healthcare. I wrote a book entitled From the Other Side of the Couch: Candid Conversations with Psychiatrists and Psychologists, published by Praeger a million years ago, and Perer’s book reminded me of it, but with more so a policy forward bent, which I really appreciated. It is an indictment told through human stories — stories of what happens when policy, profit, bureaucracy, and technology outrank listening.
Here’s what other have said about it:
“This book should be required reading for all clinicians and patients who are serious about transforming American healthcare.” — Joseph S. Alpert, MD, Editor-in-Chief of The American Journal of Medicine
“Dr. Kowey has done an outstanding job of explaining how profit has utterly corrupted the US healthcare system — driving caring, capable physicians out of practice, while lining the pockets of hospital administrators, pharmaceutical companies, and medical device manufacturers. Read and weep.” — Barbara H. Roberts, MD, FACC, author of The Truth About Statins
“These clinical anecdotes are poignant, precisely chosen, and fluently written.” — Robert Fenichel, MD, former Director, Cardiorenal Division, FDA
“An engrossing compendium of medical stories that expose serious flaws in our increasingly heartless healthcare system. This book is a call to action. Changes must occur so practitioners no longer face systemic hurdles that waste their time and block their ability to provide high quality care to their patients. ” — Andrea Leonard-Segal, MD, former Director, Division of Nonprescription Drugs, FDA
“Dr. Kowey has illuminated brilliantly many of the pitfalls in U.S. healthcare today, along with their causes, using patient vignettes. Helpful guidance is offered to patients as they navigate our dysfunctional healthcare system until vast improvements in US healthcare delivery are in place.” — Ralph Brindis, MD, MPH, MACC, Past President, American College of Cardiology
“Failure to Treat explains the problems with U.S. health care and how we got here. Kowey uses stories of failure in the medical system to explain how we can advocate for our care. It will be a great addition to health humanities classes and a resource for patients who want to know more. Given the current failures of U.S. healthcare, the book is a timely and necessary call to action.” — Ann E. Green, Professor, Clinical Bioethics and English, Saint Joseph’s University
The Crisis Is Not Merely Clinical. It Is Moral.
Dr. Kowey’s argument is powerful because it begins where all medicine should begin: with stories. The stories in Failure to Treat are composited true accounts of patients and practitioners harmed, sometimes fatally, by a healthcare system that has become fragmented, financially distorted, technologically burdensome, and administratively overgrown.
The topics are painfully familiar: insurance denials, drug overpricing, defensive medicine, frivolous litigation, private equity takeovers, physician replacement, medical deserts, misleading advertising, electronic medical record failures, and administrative harm. Each problem sounds systemic until it happens to your parent, your spouse, your child, your patient — or you.
We talk about healthcare as if it were an industry first and a covenant second. That may be the original sin of the modern system.
The Electronic Medical Record Was Supposed to Help. Too Often, It Hurts.
Consider the now-common reality of clinical documentation. Physicians spend vast portions of their day feeding the record, managing the inbox, clicking boxes, chasing messages, and reading massive computer-generated notes that obscure rather than clarify. What used to be a cogent two-page consultant letter can become a twenty-page data dump.
Technology is not the enemy. Poorly designed technology, misaligned incentives, and non-interoperable systems are. When records do not communicate, clinicians compensate with time they do not have, patients pay with confusion they did not cause, and safety can suffer in ways that are both predictable and preventable.
Artificial intelligence will not magically solve this. Used wisely, AI may summarize records, flag risks, reduce clerical burden, and improve access to relevant knowledge. Used carelessly, it may amplify bias, hallucinate certainty, deepen surveillance, or become one more administrative layer between doctor and patient. The question is not whether medicine should use AI. It already does. The question is whether AI will restore attention — or further monetize distraction.
Profit Has a Way of Redesigning Care
One of the most unsettling themes in Dr. Kowey’s work is the way financial incentives quietly reshape clinical decisions. Screenings marketed to the “worried well,” overuse of imaging, procedure-driven compensation, insurer denials, pharmacy middlemen, and hospital branding campaigns all have something in common: they can look like care while functioning as commerce.
Patients are not naive. They know when they are being rushed. They know when the prior authorization process is not about science but cost avoidance. They know when a hospital has money for a “patient experience” initiative but not enough nurses at the bedside. They know when a bill arrives that no ordinary human being could decode.
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Physicians know it too. They see the RVU treadmill, the checkbox culture, the peer-to-peer phone purgatory, and the growing sense that the medical profession is being converted from a calling into a throughput machine. A system that forces good clinicians to practice bad medicine efficiently is not merely inefficient. It is dangerous.
The Return of the Patient-Physician Alliance
The encouraging part of Failure to Treat is that it does not leave readers in despair. Dr. Kowey is very clear: patients must become informed advocates, and physicians must recommit to the individual patient in front of them, even while working collectively to reform the system around them.
For patients, advocacy means asking questions, bringing someone trusted to important visits, requesting plain-language explanations, keeping personal copies of key records, challenging inappropriate denials, and seeking second opinions when the stakes are high. It means recognizing that “approved” does not always mean necessary and “denied” does not always mean inappropriate.
For physicians, advocacy means refusing to let cynicism win. It means mentoring younger clinicians, policing unethical behavior within our professions, insisting on evidence, confronting misinformation, and supporting one another in the face of burnout and moral injury. It means remembering that every policy eventually becomes someone’s lived experience.
What Reform Should Actually Protect
Healthcare reform cannot simply mean cutting, consolidating, digitizing, or sloganizing. Reform worthy of the name must protect access, scientific integrity, clinician time, bedside care, research, public health, and the trust that allows healing to begin.
We should be wary of proposals that reduce coverage, weaken regulatory agencies without improving accountability, destabilize the healthcare workforce, or hand even more power to insurers, pharmaceutical companies, and private equity interests. At the same time, we should be equally wary of defending a status quo that is failing too many patients and exhausting too many clinicians.
The path forward is neither nostalgia nor technocracy. It is a recommitment to the human work of medicine: listening carefully, communicating clearly, using evidence honestly, pricing fairly, staffing adequately, and designing systems that help clinicians care rather than forcing them to constantly work around the machinery.
Hope, But Not Passive Hope
Am I hopeful about reform? Yes — but not because systems reform themselves. I am hopeful because patients are increasingly informed, clinicians are increasingly honest about moral injury, and books like Dr. Kowey’s translate policy failure into stories no one can easily ignore.
A year from now, I would hope Failure to Treat has done more than sell copies. I would hope it has helped patients ask better questions, helped clinicians feel less alone, helped medical educators teach systems awareness alongside anatomy and pharmacology, and helped policymakers remember that a spreadsheet is not a bedside.
Medicine is still filled with people who entered the field to relieve suffering. That is no small thing. The task before us is to build — or rebuild — systems worthy of that impulse.
If you are a patient, stop being a passive passenger in a system that profits from your confusion. Become an informed partner in your care. If you are a clinician, keep telling the truth about what the system is doing to care. If you are a policymaker or leader, spend less time admiring dashboards and more time listening to patients and bedside professionals. Healthcare will not be restored by abstraction. It will be restored by courage, humility, evidence, and the stubborn insistence that healing remains a human act.
Be sure to listen to our conversation on your favorite platform, Dr. Kowey offers candid insights, practical advice, and a hopeful vision for a healthcare system that puts people — not just diseases — at the center of care. Whether you’re a healthcare professional, patient, caregiver, or simply curious about the future of medicine, this conversation will challenge your assumptions and leave you better equipped to navigate your own healthcare journey.
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