Perhaps you’ve heard the hypothetical scenario where a run-away train is hurtling toward five people tied to the tracks. You have the choice to pull a lever and divert the train down another track that has one person tied to it. Where do you send the train? OK, imagine the same train heading toward the same five people, but now there is no side rail — the only choice is to either let nature take its course or throw an obese person onto the tracks whose girth will stop the train. The second scenario is one way to describe the choice millions are facing regarding health insurance.

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