It's been weeks since 15,000 New York City nurses began their Jan. 12 strike, holding the line for the most basic standards of safety and care: enforceable staffing ratios, real on-unit security, paid health care for health care workers and protections against workplace violence. These are not radical demands. They are the bare minimum required to keep patients and nurses safe and alive.

After 31 years as a registered nurse working in the trenches of humanity, I have come to understand something deeply disturbing. The health care system is not failing.

Sure, it is failing us – the people who give care and the people who need it. But it is succeeding spectacularly for those at the top.

When people say the system is “broken,” they are speaking from lived harm: delayed care, burnout, violence, injury, debt and moral distress. That harm is real. I have lived it. I have watched patients suffer needlessly, colleagues burn out and health care workers go without care themselves. But calling the system “broken” suggests malfunction. After three decades inside the system, I know this is not malfunction. It is design.

That design shifts risk downward and profit upward. It breaks bodies at the bedside while protecting balance sheets in the boardroom, letting health care CEOs earn tens of millions of dollars a year.

In a functioning health care system, illness would be treated as a shared human responsibility and healing would be the goal. In the United States, disease has instead been transformed into a revenue stream.........

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