Your story is puzzling for several reasons. Paxil (paroxetine) is off-patent and now costs $15/month. For many patients, it is the best choice - really a lifesaver. Might it be possible that your physician decided it was the best choice for you after examining you carefully and knowing something about your history, and not because of a free lunch? Maybe he took your complaints seriously, rather than just suggesting a change in work environment and sleep habits?

Typically, patients ramp up to a therapeutic dose of SSRIs over several weeks. These drugs require considerable time to achieve any effect. It's unlikely that one or two pills would have had the effects you describe.

Nonsense. A friend with rheumatoid arthritis was overcome with severe abdominal pain one Saturday. She needed a CT scan, but to save money National Health has shut down its Lancashire imaging centre on weekends. For a while they allowed people to pay for veterinary imaging but the newspaper headlines forced an end to the practice ("My cat could get scanned, but I couldn't!"). NICE decides what drugs people get, and how long they have to wait for surgery (another friend has waited three years so far for a bunion repair).

The Medicare statistic is misleading. Medicare mostly pays huge hospital bills so its overhead inevitably will be less than an insurer that covers well-patient care and small claims. Also, in my area it's getting very difficult to find a doctor who accepts Medicare for payment. Medicare sets reimbursement and coverage by bureaucratic fiat. If you want something more, or to see a physician outside Medicare, you're out of luck.

Holman Jenkins pointed out that "We already bribe, through supremely asinine tax policy, the most affluent, capable consumers on the planet not to use their smarts to make sure the system returns value for money."

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