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When the Affordable Care Act expanded health care coverage for many Americans, the insurance premiums for many insured Americans went up. I'm not sure why this is surprising.

Republicans are absolutely right in saying that we can not afford the future cost of Medicaid and Medicare. Democrats are absolutely right in saying that, as a moral, affluent society, we can not let people die because they can't afford healthcare.

There is only one solution to this dilemma. We have to begin addressing the cost of health care.

Other developed countries spend half as much on health care and they cover everyone. In addition, the quality of that care is at least equal to ours. If we spend $2.6 trillion every year on health care, you have to wonder what has happens to that extra $1.3 trillion. The answer is painfully simple — waste and exorbitant profits. Yes, the health care industry is the most profitable sector of our economy. Why is there no mention of this obvious solution in the heated debate in Washington? Maybe it has to do the $30 billion the health care industry has spent lobbying our Congress over the last 10 years.

How do we reduce costs? First, we need to stop spending tens of billions of dollars every year on medical tests, treatments and procedures that have no value.

Second, we need to provide end-of-life care that enhances the quality of life. Every year we spend a half trillions dollars on end-of-life care, much of which does not accomplish this.

Third, we need a primary care-based health care system that focuses on prevention of disease rather than a specialty-based system that just treats disease.

Last, we need to give up the distinction of being the only developed country in the world that allows pharmaceutical companies to charge whatever they want.

Please contact your representatives in Washington and let them know that cost is the problem. They seem to have missed this. Let them know that the solution is not some half-baked political charade of a bill. Tell them to shore up the Affordable Care Act while they roll up their sleeves and do the hard work of finding a long-term solution by addressing the crippling cost of our health care system.

Douglas Douville, MD, MPH, is a family physician working at the Maliheh Free Clinic in Salt Lake City.