Nearly every state legislator has said that the state needs to do more to help its citizens secure the key to the world's most advanced medical care right here in Pennsylvania -- affordable health insurance.

Nearly every legislator also has supported a program that, since 2003, has provided countless specialist physicians the ability to continue their medical and surgical practices in Pennsylvania.

The program, Mcare Abatement, has contributed considerably to the stabilization of the physician supply in Pennsylvania by helping pay for medical liability insurance coverage and thereby making medical practice here more competitive with neighboring states. It has kept Pennsylvania in the top tier of states with premier medical research and state-of-the-art medical care.

But the Mcare Fund, which still carries a $1.8 billion unfunded liability, needs to be addressed substantively so that this major barrier to physician retention and recruitment is removed. Nearly every legislator has said that as well.

Gov. Ed Rendell's funding proposal to offer affordable health care coverage for some 800,000 uninsured adults also goes a long way toward assuring that there is a continued supply of talented physicians to treat our citizens by continuing the Mcare Abatement Program for the next 10 years. So why is there legislative gridlock on a plan that wisely addresses both the funding of insurance for those most in need, while continuing the most successful physician retention plan in recent memory?

The Pennsylvania Orthopaedic Society believes that the gridlock is being perpetuated by a struggle over the use of the surplus monies accumulating in the Mcare Fund. We understand the original intent was to fund the abatement program and to retire the $1.8 billion unfunded liability, if possible. However, it has become apparent that this surplus, with some augmentation, can be used to accomplish these goals and the governor's proposed "Cover All Pennsylvanians" health care insurance program.

As we understand it, CAP is a voluntary program. Participating small businesses and individuals would seek basic coverage through the health insurance market and would be required to contribute a portion of the premium costs. The state would supplement the costs. CAP is ironically similar to the Mcare Abatement Program in that it provides assistance in acquiring necessary insurance coverage.

In November, Rendell proposed four funding mechanisms to achieve these goals. The original CAP funding plan used an employer payroll tax. Understandably, this option was unfavorably received by employer groups and many legislators. An alternative currently gaining support uses a combination of so-called "sin taxes" and part of the Mcare surplus to raise the necessary funds. This proposal, which is supported by Democrats in the House and Senate, would increase the cigarette tax by 10 cents and impose a tax on smokeless tobacco and cigars.

In 2003, the governor and the General Assembly enacted a 25-cent tax on cigarettes to create the Mcare Program, which has been credited with stabilizing Pennsylvania's physician exodus after the height of the medical liability crisis in the early part of the decade.

Doctors and especially high-risk specialty surgeons, including orthopaedic surgeons, trauma surgeons, obstetricians and emergency room physicians, continue to need support from the program to continue practicing. We represent the 900 orthopaedic surgeons in Pennsylvania who treat patients with bone, joint and muscle injury or disease. Orthopaedic surgeons are critical members to the team of physicians in hospital emergency rooms and trauma centers.

Most people agree that a health care system without specialty doctors falls short of the quality of care we expect. Similarly, it is unacceptable to deny health insurance for basic medical services to so many of our neighbors and families. It is an undeniable fact that health insurance has become so expensive that, according to state data, 71 percent of Pennsylvania's uninsured adults are actually employed.

The governor's unique proposal addresses these two fundamental components of a strong health care system: quality doctors and health insurance for patients.

That's why orthopedic surgeons support the governor's proposal to use a portion of surplus revenue in the Mcare Abatement Program to provide affordable health insurance for uninsured adults, while at the same time guaranteeing doctors 10 years of Mcare Abatement and retiring the fund's $1.8 billion unfunded liability as the state's excess medical liability insurance program is shifted to the private sector.

TENS OF THOUSANDS of Pennsylvania's doctors are waiting to see if they will be able to afford to practice medicine here after March 31, the deadline Rendell has set for enacting the Cover All Pennsylvanians program. At the same time, hundreds of thousands of Pennsylvanians are waiting to see if they will be able to afford the health care insurance they need to access medical services outside of an emergency room.

As surgeons, we do not spend time in the operating room debating how a patient broke his or her femur; we immediately get to work fixing the leg so the patient can be healthy again.

There are several competing plans in the General Assembly, offered by members from both sides of the aisle. It's time for our lawmakers to come together and work out the final details of a plan to keep doctors practicing here and to open their doors to more patients in need of care. Such a plan would benefit all who depend on high quality, affordable medical care in Pennsylvania.

JON B. TUCKER, M.D., is president of the Pennsylvania Orthopaedic Society.