Right now, very little responsibility rests with us as the consumers. Health care would presumably be more cost-effective if we did have more responsibility.
Right now, most of us who are insured are insured through our employers. We do not get much say in picking our insurance plans and we have little incentive to reduce the amount of care that we are receiving. Ideally, health care would be like other products. Ideally, we would pick our own insurance policies based on what kinds of care we want and what sorts of premiums and deductibles we want. This would also give us an incentive to avoid using unnecessary health care. So far, this has not happened, but it will need to happen if we are to reduce our costs.