But that's been the history of Medicare and Medicaid, especially when it comes to paying for the fastest-rising part of health-care costs - prescription drugs.

State-run Medicaid programs for the poor have taken very little advantage of their buying power to negotiate the same kind of discounts that private insurance companies routinely dicker for their clients. The new federal Medicare prescription drug benefit includes a specific prohibition against bulk-buy deals from the drug manufacturers.

But, while the light bulb has yet to appear over the heads of anyone at the federal level, states are starting to figure out things cannot go on as they are. Thus the welcome news that Gov. Jon Huntsman Jr. is looking at a couple of ideas that he hopes could trim as much as $14 million from the $210 million annual cost of drugs for recipients of the Utah Medicaid program.

One is to work with physicians to develop a list of lower-cost generic medicines that should be appropriate for most cases and to encourage doctors working with Medicaid patients to, as much as is prudent, stick with that list.

The other is to join with other states, in a consortium already being put together by Maine, to negotiate the bulk buying of prescriptions that is quickly becoming the norm.

With the continuing hikes in medical costs and the deficit pressure on the federal government's ability to pay for anything, the pressure on states and individuals is growing. The Wall Street Journal reported recently that more and more middle-class families are enrolling their children in state-funded insurance plans intended for the poor, as those families' regular employer-provided health plans disappear or are priced out of reach.

Between the giant cost of the Medicare prescription plan - estimates have soared in just the past few months from $400 billion to more than $700 billion - and the back and forth levels of benefits to the needy, we have already sought to balance the budget on the backs of the taxpayer and the poor. It's time for the big drug companies to contribute a little, too, by taking discounted prices for their wares.

Otherwise, the day will soon come when no one, individual, insurer or government, can afford them.