Choices need comparisons

We are confronted constantly with the prospect of change. Change itself is a different matter: once it happens, all we can do is figure out how to deal with it. But the prospect -- that involves decision-making, whether we are trying to decide whom to vote for or whether to buy a new car, or how we feel about proposed health-care reform.
Too often, the choice is presented as being between the status quo and the new arrangement -- usually a bogus choice, since if we reject the change, the status quo will change in some other direction, and that's what we must calculate and compare with.
An example: Forty years ago when I was living in Charlotte, before the advent of its expressway system, I attended a neighborhood meeting hosted by city officials to present plans for the first segment of downtown expressway. Wonderful. With these wide straight expressways, everyone will be able to zip around town without worrying about traffic. What could be better? Then I raised my hand, knowing what I had seen during a year in Germany: "What provision is being made in all these expressway plans for mass transit?" Silence. Then the response: "None." The shocked look on my face must have convinced the speaker that more explanation was in order: "People in Charlotte prefer to ride in their own cars."
So here's what I'm talking about: The speaker was, without really thinking about it, implying a choice: We can either drive our own cars, or we could ride in Charlotte's existing buses -- dirty, noisy, unreliable, and slow. And it's perfectly clear what any sensible person would choose. The other possibility -- fast, clean, quiet, dependable, modern trains, buses, and streetcars -- was not part of the calculation, and no one considered offering that alternative to the citizens.
In our personal choices -- say, whether to buy a new car or heating system -- it's also a choice between at least two options: What will my total costs be over five years with a new car, vs. keeping the old one? The old one is paid for, so no car payments that way. But what about repair costs? What about costs if the old one dies on the road, miles from home? This is the difficulty with using the status quo as one of the options -- the status quo will change, but how?
Without going into all the arguments in the health-care-reform debate (let's save that for another day), let me just point out that this involves the same kinds of choices. First, we can look at one of the proposed new plans. How will that work for me? for the typical person? for a person with a "pre-existing condition"? What will the actual costs (premiums, co-pays, out-of-pocket payments) be, under this or that set of conditions?
But then, what are we comparing that with? If the comparison is with the present system, we have to run through all the same possibilities, as with the new plan being considered. And -- the hard part -- we have to factor in the likely changes in the existing system, starting with the fact that the existing system is not static but is getting 8% more expensive every year.
In other words, it's not sufficient to dismiss the proposed new program with, "It's too expensive." The question is, "How expensive will the new plan be (for you and me, for the government, for people without insurance now, etc.) compared to how expensive it will be -- with future cost increases -- for all these various groups if we don't implement one or another of the proposed plans?"