So the trolley problem has had a bunch of different forms, trying to change the parameters and see what matters to people, things like age or whatever. How about instead we just change how the scenario began.

There's five people on one track and the other is empty and the trolley will go down the empty path. A person comes along and flips the lever so the trolley will now run over the five people, and they themselves get onto the other track for one reason or another. So now the scenario is the same as before, five innocent people on one track, one innocent person on the other, a trolley is coming down the line, and you can flip the lever, dooming the single innocent person and saving five lives.

You might feel that the single person isn't innocent, they were dooming other people by flipping the lever first, but at this moment in time they are still innocent, nobody has died yet, and if they die now then it would be your fault for choosing not to save them. But choosing to switch the tracks and killing a single person, saving the lives of many, that's still your fault.

But this introduces a new problem. If you stopped them from flipping the lever in the first place, and so they never got onto the tracks, would that be better than flipping the lever once they'd gotten settled in? Would it be better to prevent people from taking advantage of others for personal gain in the first place, especially when lives are on the line? Should things like health insurance be banned because it inevitably leads to either the deaths of many, or the deaths of the few who would doom them?

I don't think this trolley problem is the same as the original. In the original, the trolley running over the five people wouldn't instantly make the innocent individual on the other track turn into a murderer. But, if a decision is made that will definitely end lives that would otherwise have been saved, even if its decades after the decision, it's just as indirect a murder as flipping the lever the first time was. Unlike the trolley problem though, it's hard to get information about how many lives might have been saved if insurance companies didn't control medical procedures. All we can do is compare parts of the world that rely on health insurance for medical care, and parts of the world that pays for it through taxes.

Or, we can count the number of people who get funding online to pay for their operations, because without that funding their insurance wouldn't help them, and they would die. With this, we know of at least a few people who are on the other track. Definitely not all of them, but a countable number that are definitely there.

So, in real life the reason for the single innocent person flipping the lever and getting on the other track is because there was a lot of money on it, and a lot of people were paying them to hand them the money that was there. So, is the problem really the individual, or is it the people paying them? If it wasn't them, someone else might have done it, and why would someone build a track with all that money on it. Maybe the problem wasn't people taking advantage at the cost of others lives, maybe the problem is that the lever was the only way to reach the money, or that there was money on the track at all. Maybe the solution was brakes for the trolley, and to not make it profitable by dooming people.