> I don't think reducing that from 3 choices to 2 is going to be a big win for user friendliness

It’s nowhere near as simple as 3 settings now there are different antialiasing techniques, path tracing lighting or reflections, upscaling (multiple algorithms) etc.

Nothing is all just fully positive and each has tradeoffs

Those are typically incorporated into the presets. I am not just talking about Low, Medium, High for individual settings. There's almost always a preset option that will set all the other settings according to what's deemed appropriate by the developer for the selected quality level.