Book Surgeon No. 22

For as long as I can remember, indecisiveness has played an outsized role in my life. Decisions of all sizes have a tendency to cause more stress than I would like. Getting ice cream as a kid, for instance, would become a mission to get the best ice cream flavor available. No matter what I chose, I constantly imagined what the other flavors would have been like–wondering if I could have made a better choice. This thought process would always lead me to over analyze my choice, which diminished the pleasure of the chosen experience. This would happen for most decisions–what to order at a restaurant, where to go to school, what to do with a free saturday, etc. Thus, reading Barry Schwartz’s book The Paradox of Choice: Why More is Less felt particularly applicable to my lived experiences, and many of the book’s themes could be felt in the world around me. 

Near the opening of the book, Schwartz establishes what he believes to be the paradox of our times: a desire for more control of our life alongside a desire to simplify our life. As the number of choices available to us increases, we gain more control over our lives, but the tradeoff is a loss of simplicity in our life. As Schwarz writes, “not too long ago, only one kind of health insurance was available to most people … [but] nowadays, organizations present their employees with options–one or more HMOs or PPOs. And within these plans, there are more options–the level of deductible, the prescription drug plan, dental plan, vision plan, and so on.” On the one hand, this shift allows us to personalize health insurance to the level of the smallest details, vastly expanding the scope of opportunity available to us. However, the breadth of choice is a double-edged sword as “a bad decision by a senior citizen can bring complete financial ruin.” And with everyone making their own decisions, it is impossible for a central body to ensure every single person is making a sensible choice. Further yet, making a choice with so many options is tiring and burdensome. What is my copay and deductible? Is there an out-of-pocket maximum? Should I open a Health Savings Account (HSA) because of my deductible? Do I want a PPO or HMO? How will it affect my care? Is my doctor in-network or out-of-network? What happens if I move? How will a change in income affect my premium payments? Should I include a dental plan, a prescription drug plan, or both? What drugs do I want to be included in my plan? Is the brand name drug better than the generic? Are both covered by my insurance? Each of these questions are difficult and would require extensive research to make a somewhat informed decision. The idea of additional choices sounds great in theory, but in practice, it becomes harder and more draining to make decisions. Soon, we will all need to hire private consultants to help us choose a healthcare plan, a retirement plan, etc. Dr. Atul Gawande, surgeon and writer, discusses individuals’ aversion to the burden of choice in the context of making health decisions. He “reports that research has shown that patients commonly prefer to have others make their decisions for them. Though as many as 65 percent of people surveyed say that if they were to get cancer, they would want to choose their own treatment, in fact, among people who do get cancer, only 12 percent actually want to do so.” And as Schwartz further notes, “time spent dealing with choice is time taken away from being a good friend, a good spouse, a good parent, and a good congregant.”

With a clearer understanding of the toll that complex decisions have on us, what can we do to ease this burden without diminishing the quality of our lives? One piece of advice by Schwartz is to “choose when to choose.” Figure out where customization is most important in our lives, so we can spend time making decisions in these realms. Then, look for ways to restrict the number of choices for decisions that are less important to us. Another strategy for improving the satisfaction of our decisions is to “satisfice more and maximize less.” Becoming “a satisficer, however, requires that you think carefully about your goals and aspirations, and that you develop well-defined standards for what is “good enough” whenever you face a decision.” Finally, to mitigate regret, aim to reduce “the number of options we consider before making a decision … [and practice] gratitude for what is good in a decision rather than focusing on our disappointments with what is bad.” There is no doubt that we have more choices available to us than ever before. Thus, in light of this trend, we can use Schwartz’s strategies to make decisions that make us happier and more content, which is arguably more important than the actual outcomes of most of our decisions.

Share with others if you enjoy! Thanks for reading and see you next week!