Cheap as I am – my car is 11 years old and the three wood in my golf bag cost $20 – I would have paid to see the faces of the CEOs of America’s pharmaceutical companies when the U.S. Supreme Court recently gave provisional approval to the so-called Maine Rx program. Not much flushes the Bermuda tan of a CEO who makes millions, but I bet that did it.

The Maine Rx program, in which the state of Maine uses its purchasing clout to get prescription drugs at a discount for lower-income Mainers who have no prescription drug insurance, had been tied up in court for the last three years by a pharmaceutical industry suit. Not anymore.

For the pharmaceutical industry, Maine Rx was never about Maine. The state has more lobsters than residents (about 1.2 million – people, that is), and only 375,000 of its residents were to be covered by Maine Rx. Maine’s collective spending on prescription drugs probably does not amount to much more than the $240 million collective salaries of the CEOs of the industry’s 10 top companies (in 2001 those salaries ranged from $8 million to $70 million).

The court’s decision to untie Maine Rx has the pharmaceutical industry reaching for its heartburn medicine because of the frightening possibility that “As Maine goes, so goes the nation.” That is why America’s most profitable industry, which makes a living selling pharmaceuticals that are supposed to help people, sued in court to block a program aimed at helping lower-income people buy its pharmaceuticals. Consider these bubbles of painful Maine Rx gas for the pharmaceutical industry:

. eleven other states are considering legislation similar to the Maine Rx program. The industry held them off by pointing out the legal questions surrounding Maine Rx. The Supreme Court action kicked the legs out from under that stand, and some of those states will now pass their own versions of Maine Rx;

. two of the Maine Rx program authors are now on the national political stage, where they can help promote the concept to a national audience. Michael Michaud is now a U.S. congressman from Maine, and Chellie Pingree is now the head of Common Cause, the national consumer advocacy group;

. Michaud has now drafted a bill for Congress to implement an “America Rx” program, a nationwide version of the Maine Rx program;

. two of the U.S. Senate’s most influential moderate Republicans – Olympia Snowe and Susan Collins – are from Maine, the national hothouse for prescription drug legislation;

. the pharmaceutical industry’s objections to Maine Rx were rejected by the court even though the Bush administration argued against the program in a brief to the court. Sometimes it does not pay to have friends in high places.

The Supreme Court’s ruling also maintains the key avenue of state-by-state action for progress in the fight for more affordable prescription drugs. That fight has gone nowhere at the national level, obstructed as it is by the influence of the pharmaceutical industry in Washington. That is why there is no prescription drug benefit for Medicare patients. If the pharmaceutical industry shuts down state initiatives such as the Maine Rx program it effectively shuts down effective initiative everywhere. With the court’s decision, the industry will continue to have state initiatives to lower drug costs nipping at its Gucci-clad heels while it lobbies against meaningful action in Washington.

The Maine Rx decision may also advance the cause of a prescription drug benefit for Medicare patients. (Another Medicare prescription drug benefit bill – the sixth in five years – is currently winding through Congress and will not pass without continued heat from the public.) Success of the Maine Rx program in court is a signal to Washington politicians in both parties that the high cost of prescription drugs is politically unacceptable, that something must be done, and that if Congress fails to do the job, states will. A Medicare prescription drug benefit is a chance to do something, even if only for Medicare recipients.

Drugs are one of the hammers of medical care (the other being scalpels), and are simply the most effective treatment of many ailments. Without those medications most medical care is just expensive advice and I am just another dashing, debonair guy in a white coat with a prodigious vocabulary. Every day that I work some patient tells me he or she is choking financially on the cost of their medicines and can no longer swallow that cost, meaning effective treatment is beyond their means in the world’s richest country. That has to change, and laws such as the Maine Rx program may help bring about that change.

Pharmaceutical companies are entitled to reasonable profits; they need to make reasonable profits to develop new medications and pay stockholders. They do not, however, need to make enough money to pay CEOs $20 million salaries, and to spend more on marketing than they do on research (which most do). The U.S. Supreme Court’s recent action on the Maine Rx program means that for once the pharmaceutical industry must gag down a bitter pill of its own, a pill that is good for what ails the rest of us.

Erik Steele, D.O. is a physician in Bangor, an administrator at Eastern Maine Medical Center, and is on the staff of several hospital emergency rooms in the region.