Ian Gershengorn, a Justice Department lawyer representing the administration, said the health insurance market is unlike any other, since all Americans at some point get medical care.

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Yet managing the medical care of 313 million Americans will involve problems of scale and complexity unlike those of managing the care of 60 million Brits or 35 million Canadians.

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Dr. Wayne Burton , Bank One's medical director, explains that obese employees, unlike smokers, are not required to cover their health care costs because the company doesn't want to be seen as discriminating against obese employees, or to create the impression that it considers obesity a purely behavioral issue.

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