For the 7,500 people who get health coverage under the "health trust'' sponsored by the Montana Contractors Association, things couldn't be simpler.

It comes at no premium cost to the employees of the 70 companies participating in the plan. Whether you're 19 and single, or 45 with a family of five, you and your dependents are covered.

The benefits for everyone are the same; you don't have to sift through a smorgasbord of co-pays, deductibles, managed care or "provider networks."

It comes with a per-person/family deductible and 80 percent coverage of most expenses beyond the deductible. Administrative costs are relatively low for the self-insured, nonprofit plan.

"Our plan is a good example of what could be done when we get together as far as employees, employers and providers, to make plans reasonable and cost-effective," says Martell Hilderbrand, the trust's director in Billings. "It's not fancy, but it's effective and it works."

Might this be a model for the future of health insurance, that everyone could agree on as a laudable goal?

Nope. Not even close.

For as good as this or any other alternative may sound, there is no clear agreement on how Montana or the nation should move to provide health insurance coverage for the 45 million people without it, including 170,000 in Montana.

Montana's 2007 Legislature wrestled with the global issue of health insurance on several fronts this year, and in the end decided to study it over the next 15 months.

The study resolution, sponsored by Rep. Gary Maclaren, R-Victor, says a special committee must examine how to create "universal, portable, affordable private health insurance for all Montanans," while maintaining publicly funded health insurance programs like Medicare.

Maclaren says he's hoping the study recommends a "health insurance exchange," an idea being pushed by conservative think tanks that would enable those without insurance to buy a private policy they can take from job to job.

"It would give people more selection of product and portability," he says. "Usually with an employer, you get one or two choices, but that's it. And maybe it fits and maybe it doesn't. ...

"I think the more choices you have, the better."

The Legislature killed a measure sponsored by Sen. Christine Kaufmann, D-Helena, that would have required a state-sponsored "working group" to design a plan for universal health coverage for all citizens, regardless of their ability to pay.

The bill passed the Democrat-controlled Senate, but was killed by the Republican-controlled House Appropriations Committee.

Kaufmann's bill didn't specifically mention a single-payer, government-run insurance program for all, but she believes the working group would have decided that's the best solution.

"I think we have to recognize that the 'market' is not the best mechanism for every issue," she says. "It's failed (for health insurance). It's time to look at solutions where government is more involved."

This philosophical argument is at the crux of the debate over how to solve the dilemma of 170,000 Montanans and millions of Americans without health insurance: Is the free market the answer, with some tweaks and subsidies to make things more affordable? Or is it time for government to do the more or all of the job, removing the profit motive from health insurance?

The contractors' health trust, although rooted in private enterprise, is an amalgam of both philosophies.

Began in 1988 by the state's leading contractors who wanted to offer insurance as an incentive for employees, the trust is a nonprofit entity that uses the "premiums" paid by member companies to finance health benefits for everyone covered by the plan.

The $15 million health trust is not an insurance company, it pays no dividends or returns to shareholders, and it keeps administrative costs in the range of 8 percent to 9 percent. The contractors also have a $45 million retirement trust.

"We have a staff of five people overseeing our retirement and health benefit plans," says Hilderbrand. "There are no big CEO salaries here. We don't get six figures. We believe in what we do."

Member companies pay a health-insurance premium of $3.95 per hour per employee, up from $3.65 last year. All eligible employees must be covered.

Tony Stonehouse, resource manager for Dick Anderson Construction in Helena, says the plan is a "strong recruiting tool" for the company, especially for workers with families, who would be covered by the plan.

"The coverage is so good, that we seldom ever get complaints on it," he says. "I think it's probably the best plan around, as far as what it has to offer."

The plan has seen its costs go up about 8 percent a year in recent years. In response, the plan has both raised rates and reduced benefits -- but also added a "wellness benefit" of preventive care that is 100 percent covered, Hilderbrand says.

Construction workers employed by companies in the trust can move from job to job and still maintain coverage. They also have an "hour bank," where employees can work more than 120 hours a month and use that additional time to accumulate coverage they can use later, for up to six months when they're not working during the off-season.

Hilderbrand says the secret has been keeping the plan basic and simple.

For example, it has no pharmacy card. Those wanting to buy prescription drugs must buy them up front and then get reimbursed, applying first the deductible and then their 20 percent share.

Members end up paying a bit more for drugs, but usage is much lower than if people simply had a card that allowed them to pay a flat fee for prescriptions, thus saving the plan much money, Hilderbrand says. Yet, the plan will reimburse members 100 percent for the cost of generic drugs.

A few similar health trusts operate in Montana, and the Montana Medical Association is in the process of setting one up for physicians, most of whom now must buy individual policies for themselves and their families.

Hilderbrand says the contractors' plan is a good one, but doesn't see the model as the cure-all for the health insurance ills facing Montana or the country.

"There is no silver bullet, there is no quick fix," he says. "We need to get more healthy. We're not very healthy. It's going to be a long-term thing."

Yet Hilderbrand says the simplicity of the health trust is a model he'd recommend. Once health insurers, companies and their workers start demanding all variations of plans and benefits, the cost starts going up, he says.

"I challenge anyone to tell me any different," Hilderbrand says. "At some point you've got to realize you can't be all things to all people and have what I call the drive-through mentality. This isn't Burger King. You can't just have it your way."