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Sister Rita Larivee, SSA, NCR associate publisher

Imagine 10 hungry people standing in line waiting for food to be served. Two of them haven't eaten in five days, two haven't eaten in four days, two haven't eaten in three days, and so on.

As the food comes out, a notice goes up letting everyone know that the food is only for the neediest among them. Everyone else must fend for himself or herself.

Two questions emerge. Who gets to eat? What is everyone else to do?

The scenario is similar to the current situation facing Maine's new prescription drug 1program (known as Maine Rx) designed to reduce the cost of medicine for the poor and the neediest. PhRMA (the Pharmaceutical Research and Manufacturers of America) sued to stop the program charging that it violates the supremacy and commerce clauses of U.S. Constitution and conflicts with federal Medicaid regulations.

Yesterday, the Supreme Court lifted a lower court order blocking the implementation of the program. But the decision also left the door open to future litigation.

The Maine program is intended as a means for providing prescription drugs at more affordable prices to the widest number of people. It allows the state to restrict a drug company's participation in Medicaid if a manufacturer refuses to negotiate with the state to extend price rebates and discounts usually reserved for Medicaid recipients to all patients. Medicaid provides medical coverage for those who have exhausted their assets.

No one disagrees with the obligation to assist those qualifying for Medicaid, but to ignore the urgent need among other needy populations is like trying to decide who's more in need of food: the one who hasn't eaten in five days or the one who hasn't eaten in four days. National definitions of poverty and need have always been controversial at best and are seen as crude measurements of the actual situation.

The opponents of the new program contend that Medicaid patients will be held hostage by non-Medicaid purposes and unable to receive the benefits due them. There is an element of truth here, but it's like saying that anyone who hasn't eaten in three days should get to the rear of the line.

The issue at hand is whether, as a society, we've come to realize that health care costs are so disproportionate to personal income that trying to distribute according to government tables for standards of living has become absurd, leaving many truly to fend for themselves.

I don't mind that the pharmaceutical manufacturers are concerned that as a society we abide by the laws we've established. But I do mind when they use for their own gain the deficiencies of laws that no longer meet the needs of the communities those laws were meant to serve.

Kudos to the state of Maine for getting beyond the rhetoric of needy, needier and neediest and to the real of challenge of health care accessibility for all.