One of the points of contention in health care reform is whether it will do enough to control costs.

Forget about the Congressional Budget Office’s optimistic outlook, as it discounts the Medicare “doc fix,” which, when factored in, will erase any supposed deficit reduction.

Reform doesn’t do very much to change the underlying structure of our health system, which continues to pay more for quantity of medical services, rather than shift the focus to value and quality.

Sharon Begley, writing in Newsweek, offers some sensible suggestions on what we can do control costs. Better incorporating the best clinical evidence into their medical decisions would help. She cites the continued, and possibly unnecessary, use of back surgery, knee surgery, vertebroplasties, and angioplasties, despite mounting evidence that they’re being overused.

One reason is the continued resistance of many doctors to change their practice habits. Another is a payment system that encourages more testing.

But a significant influence is patients themselves:

Consumers, too, are a powerful force for unnecessary medical care. Parents insist the ER do a CT scan on a child who bumped her head; runny-nose patients won’t leave their internist without a prescription for antibiotics. “In a busy practice, it’s sometimes easier to write the prescription than to talk the mom out of it” . . . And the heart patient who doesn’t believe that pills could possibly be as effective as surgery? “Angioplasties, stents, and bypass have attained ‘entitlement’ status.”

It’s not easy to repeal the “more testing means better medicine” mentality, especially when it’s so entrenched in the American psyche.

But we can start by not demonizing just doctors, but acknowledging that every medical medical stakeholder, including patients, needs to take some responsibility.