I recently visited an elderly patient in her apartment and she was watching CNN where Republican representative Justin Amash questioned how Paul Ryan’s ACA replacement plan would save the system any money. My patient smiled and in her slight German accent she said, “They always come up with these plans, but they never do anything about why all the medical care in this country is so expensive.”

In one sentence, she uttered more wisdom than so many politicians who are trying to improve healthcare delivery without understanding the cause of its dysfunction. As the U.S. Congressional Budget Office (CBO) shows, Paul Ryan’s health plan saves federal funding by dropping 24 million mostly poor and older people from the insurance roles, and reducing Medicaid funding, which pays not only for those who are poor but also for elders in nursing homes. Is that really the only way we can cut cost?

{mosads}As a primary care physician, every day opens a window into why medical costs are escalating. Every day I see patients tossed into the hospital where they suffer harm, when home treatment would have been safer, less expensive, and what they prefer.

Every day I see patients exposed to tests, procedures, and medicines that are expensive, harmful, and unnecessary, but, without understanding their options, patients are persuaded by those who profit from such interventions to pursue a medical path that is contrary to their interest.

I have seen so many cardiac stents put in patients who do not need them, stents that enrich cardiologists and device manufacturers, stents that cost the system as much as 300 of my office visits but do not help patients. I have seen so many drugs of negligible benefit tossed into elderly bodies, causing falls, fractures, confusion, and medical deterioration. And as I see this, I cringe when politicians discuss health saving accounts and tax-breaks as though they are earth-shattering innovations, and when they gloat about eliminating “entitlements” that provide people with health security and expose them (and hospitals and taxpayers who will ultimately pay their bill) to certain harm.

Unnecessary healthcare spending is estimated to be $750 billion a year, with 40 to 50 percent of what doctors and hospitals do seen as being low value care. A Washington Post article from Feb. 21 suggests that healthcare spending is projected to grow from $3.4 trillion now to $5.5 trillion in 2025 due to population aging and increasing medical prices, increases that will only cause premiums and Medicare’s deficit to explode.

A recent Atlantic article is only the most recent piece showing that so much of what we spend in healthcare is not medically necessary, and yet our system encourages and rewards such excessive spending, most of which is generated by specialist doctors and hospitals who profit from it. How can we expect insurance to be affordable and accessible until we have the courage to confront cost?

A rational cost-effective medical system must start with primary care. As recent articles by Atul Gawande in the New Yorker and Danielle Ofri in the New York Times demonstrate, the presence of primary care confers undisputed value to patients and to the system. In areas of the country with more primary care doctors, outcomes and satisfaction improve while the cost of care drops. No other medical specialty can boast such impactful results and yet primary care doctors are a disappearing species.

They are paid less than virtually all other specialists, and are forced to see patients too quickly as they confront escalating overhead, suffocating regulations, and insurance company rules that compel them to robotically follow protocols rather than being the thinking and compassionate doctors consistent with their training.

All of this diminishes their value to patients and society, while fewer students are entering primary care, instead choosing higher paying specialty fields. Allowing our low-value healthcare system to persist as we put band-aides on its gushing wounds will not realize Donald Trump’s promise, “The way to make health insurance available to everyone is to lower the cost of health insurance, and that is what we will do.”

Paul Ryan’s plan shamelessly equates cost savings un-ensuring our most vulnerable citizens, the very antithesis of what our President has promised and what our nation wants and needs.

To fix our system and make healthcare affordable we must curb the diminution of primary care and the dysfunctional specialty-based medical system that is surging in its absence. We must reward value, and enable patients to be active participants in their care. Many ideas have been presented as to how to create more vibrant primary care and to change the convoluted system by which doctors are paid.

It is time that President Trump and Congress listen to those of us in the trenches, those of us who really understand what is driving up premiums and how to bring them down, those of us who put patients first and believe that only through their wisdom can American healthcare be saved.

Let us show you how to insure more people and simultaneously cut costs and improve outcome. We are ready to talk.

Andy Lazris, MD, a primary care doctor in Maryland, is author of “Curing Medicare” and co-chairman of the Right Care Alliance primary care council.

The views expressed by contributors are their own and are not the views of The Hill.