As a physician who lives and has practiced in NYC, the largest nursing strike in the city’s history has broken my heart. It has saddened me that our nurses could not be the heroes they truly are and that hospitalized patients experiencing some of the worst days of their lives had not received the best quality care that they could and should get.

And this is just the start of a blooming crisis in front of us, because the fact that health benefits became a central sticking point in the strike involving nearly 15,000 workers reveals a crucial aspect of the affordability crisis in health care.

The irony is hard to ignore, as health systems threaten to reduce contributions to health care coverage. This conflict exposes a truth extending far beyond this labor dispute. We cannot solve New York’s affordability crisis without confronting health care affordability. Health care represents approximately 20 percent of our GDP. One out of every five dollars in the American economy goes to health care, and New Yorkers are paying some of the highest prices in the nation.

As a practicing physician who studies health care financing at Yale University, I can see both sides of this crisis. Nurses are the backbone of our health care system, including my own parents and partner. While they are not nurses at the striking hospitals, they stand in solidarity with what they see as reasonable demands for competitive benefits, support, and security. They are proud nurses who believe in nurses advocating for themselves, just as they would advocate for their patients. At the same time, the fledgling economics of hospital care that underpins this strike reveal a broken health care system.

The wage and benefit squeeze

According to publicly available financial records, NewYork-Presbyterian and Mount Sinai paid nearly $32,000 per nurse in employee health benefits alone last year. That is nearly double the federal poverty level for a single person. Put another way: If we assume 48 working weeks and a typical 40-hour week, these health systems are paying roughly $17 an hour just for health coverage.

This is happening at a time when real wages for most American workers have barely budged for decades. While wages have technically grown over the past 25 years, purchasing power, wages adjusted for inflation, has remained essentially flat, according to Pew Research. Meanwhile, health care premiums and deductibles have skyrocketed.

The nurses in this strike understand this squeeze intimately. Any reduction in hospital contributions from MSH or NYP to NYSNA’s health benefits fund would increase costs for the 44,000 people enrolled in the union’s health care plan across the state. They are not just fighting for themselves but for many of the hardworking nurses across the state.

The price problem

However, some of the same institutions that should understand the affordability issue are exacerbating the problem. NewYork-Presbyterian is under federal investigation for allegedly working with insurers to keep prices inappropriately high. According to a memo from Union Local 32BJ, a hip replacement at NYP costs their health fund an average of $83,000, compared to about $58,000 elsewhere in the city.

The union responded by implementing co-payments at NYP that were 10 times higher than at other hospitals. This approach worked, with members increasingly choosing less expensive hospitals, saving the union approximately $30 million annually. Of note, that is not terribly far off from the $26 million NYP’s CEO earned last year. When one of New York’s largest unions must actively steer its members away from a hospital because of inflated prices, we have a problem.

The hospitals’ dilemma

To be fair, hospitals are genuinely navigating difficult economic headwinds. Many were already struggling financially before the passage of HR1, the “One Big Beautiful Bill” signed this summer. HR1 will lead to massive health care cuts that will impact hospital finances nationwide. Hospitals are trying to prepare for an uncertain future coming in the next year.

Additionally, NewYork-Presbyterian and Mount Sinai have stated they never planned to cut benefits, despite earlier reporting, and were instead exploring cost-saving strategies. We also cannot forget that every part of the health care ecosystem contributes to rising costs and affordability issues. Pharmaceutical prices, medical devices, and hospital supplies, all facing inflation and tariffs, are driving up costs. These health systems operate within a fundamentally broken structure. However, large academic medical centers (such as NYP and MSH) also play a role in driving costs upward through rapid adoption of expensive technologies without clear evidence of benefit, and through consolidation, which research consistently shows leads to higher prices.

Mayor Mamdani’s first test

Several weeks ago, when Mayor Zohran Mamdani and Senator Bernie Sanders stood with nurses outside Mount Sinai West, the symbolism was commanding. But I wonder if the mayor recognized what else he was witnessing: his first major affordability crisis, hidden in plain sight.

Mayor Mamdani was one of many elected leaders who signed a letter in solidarity with the nurses. That solidarity matters. But the mayor who ran on making New York affordable must also grapple with a harder question: How does health care affordability fit into that agenda when the forces driving costs operate largely in the state and the nation’s capital, beyond City Hall’s reach? No easy answers, but if we as a city are serious about tackling affordability, we cannot afford to ignore them.

A moment we cannot waste

The strike may be over, but we cannot let this moment pass without taking stock. When we walk past gleaming new hospital wings or hear about massive hospital investments in AI, we must remember there is no free lunch. Every advancement has a cost, increasingly borne by workers’ wages or by patients, one medical emergency away from financial catastrophe.

We are witnessing a smaller-scale version of what happened nationally when rising costs on the Affordable Care Act (ACA) marketplace contributed to a government shutdown late last year. New York City is experiencing its own version of this reckoning.

The conversation about the cost of health care in New York and across the nation needs to get louder. This nursing strike has been a symptom of a much larger disease. Until we confront that reality directly, affordability will remain an aspiration rather than an achievement. Finding solutions to these problems will not be quick, and they will not be easy, but “The best time to plant a tree was 20 years ago. The second-best time is now.”

Marc Henry Estriplet is a post-doctoral fellow.