Since a healthcare system does not have to be designed in such a way that people inevitably fall by the wayside, this depiction of the trolley problem seems to me to be a pretty US-American thing.

I see it like this: the guy on the lever is also the CEO of a health insurance company and chooses the option of eliminating a competitor, accepting that his even more profit-optimized approach will lead to even more helpless people dying, which would not have been necessary if he had left everything as it was and not eliminated the competitor. The US thing about this is that there is no third option in the first place, where nobody dies because of the healthcare system. This very basic fact is not noticed, addressed or even criticized by anyone. Instead, even those who will die unnecessarily agree with the guy in charge in his decision to sacrifice them on the altar of higher profits because a hated person will die with them - they even agree with his statement that it would be for the greater good, instead of asking why it is even necessary for them to be tied to the tracks and run over.

This seems odd to me, but is probably only logical if you’re used to seeing the healthcare system as a business like any other. I don’t really get it tho.