I'm very worried about this element. It had a very strong presence in the very early versions (OD&D/Holmes, maybe 1E) and seems to have been on the decline since then.
I XPed you on another thread for your similar post - so sorry, no XP for this one!
In support of this there must be a core decisions the players make that have consequences.
PC choices in a campaign should be meaningful, with consequences. If they spare surrendering foes, maybe those guys end up working for the pcs. If they never spare an enemy, maybe their rep gets out and nobody surrenders to them any more. If the pcs keep offending the baron between forays into the Keep on the Shadowfell, they are exiled, adventure interruptus, and now they are traveling the world while Kalarel's plans come to fruition back home. If the party's fighter is always whoring it up between adventures, maybe when he's 8th level a woman shows up with a baby, claiming it's his.
I doubt that many players of RPGs deny that choices should have consequences. (Maybe Cthulhu oneshots are an exception - whatever choices you make, your PC ends up driven insane! - but these are outliers.)
But one major difference across playstyles is the nature of the consequences - why do they matter? I agree that 4e doesn't provide operational/strategic consequences, and at least as I play it, I tend to agree with the OP - yes, healing surges are a resource, as are dailies and action points, but I don't find that the play the same role as (for example) spell management by a low or mid level caster in AD&D.
For me, this is a good feature of 4e, because I tend to find operational play tedious, and a game that gets rid of operational consequences opens up a nice space for focusing on other sorts of consquences - sparing or killing the prisoners, for example, starts to matter not so much in terms of whether they'll help you or betray you or never bother you again (because if you get an NPC follower, as a GM I'll just up the level of the encounters to keep them dramatic!) but rather because it reveals your PC to be a merciful or callous or manipulative or expedient person. Mutatis mutandis for irritating the baron.
I don't think I'm the only D&D player who cares about this sort of consequence. I think similar sorts of consequences are meant to be in play in Dragonlance, Planescape and (perhaps) Ravenloft, at least.
I think a unity edition, if it is to lift up to its name, therefore has to support players who want to focus on one or another of a range of dimensions of meaningful consequence. Which is a very tall order for RPG design, because the same featuers of action resolution, encounter design etc that support operational consequences tend to impede focus on thematic consequences, whereas getting rid of them to make room for thematic consequences tends to undermine operational consequences (as the OP rightly notes).