Anyone attending last week's Montana Health Care Forum in Helena heard plenty about how health care in America needs a serious overhaul.

Yet we already knew that. With one-sixth of Americans without health insurance, a growing number of physicians unhappy with their work, and the United States blowing far more money than any other nation on health care, yet getting worse results, how could we not?

What struck me more was what we didn't hear -- particularly from experts with a national outlook.

Most countries in the industrialized, developed world have some form of "universal health care." Through government regulation or government-provided and/or financed care, these countries ensure that all citizens have affordable access to basic health care.

The United States is one of the only developed nations that does not.

Yet we heard precious little about what these other countries are doing, and whether the United States might consider adopting their model.

Canada has national health insurance, funded by tax dollars. Great Britain has a national health service, with physicians employed and paid by the government, providing "free" (taxpayer-funded) health care to all. Germany has a collection of health insurance pools, tightly regulated and funded in part by the government.

Universal health care also exists in Japan, France, Italy, Australia, Norway and Sweden, to name a few.

Health statistics for most of these countries are positive, with infant-mortality rates, life-expectancies and other health indicators often better than the United States. You'd think that in a discussion of health-care reforms, we would be looking more to these countries, to see what works and what doesn't. Why reinvent the wheel?

Instead, we heard lots of talk about solutions that would encourage or require Americans without health insurance to buy private health insurance.

A chief organizer of the forum, Montana Blue Cross/Blue Shield -- the state's largest private health insurance company -- says it wasn't trying to control or guide the content of the forum.

Conference organizers identified speakers they felt had both national and state perspectives on health issues and health reforms, and tried to get them on the agenda, says company spokeswoman Linda McGillen.

"We just wanted to get a bunch of ideas out there -- here are some things that are going on, and this is what folks are doing," she says. "We focused more on what's happening here (in Montana) and what things need to change, or what (people) are doing to change things in their state."

The talk about some sort of private-insurance solution to our health-care coverage problems, however, shouldn't come as a surprise in Montana or the nation.

Private health insurance is a huge political and economic presence in America, and can't simply be swept under the rug. It's bound to be part of any short-term reforms, and, quite possibly, longer-term reforms as well.

One of the nation's most publicized health-care reform efforts, which involves private health insurance, was aired at the forum: Massachusetts's effort to require all citizens to buy some form of health insurance. Massachusetts consumer-health lobbyist John McDonough presented a mostly positive picture of the Massachusetts program, which already has reduced the state's 600,000 uninsured citizens by one-third.

Yet his endorsement came with a strong caution.

He made it clear that it's still a work in progress, and definitely not for everyone -- and that it probably would not work in a state like Montana.

Massachusetts had only 10 percent of its population without health insurance when it began the plan last year. It also has a highly regulated insurance market, with strict controls on pricing for people who've had past health problems.

Montana has as many as 19 percent of its population without health insurance, and does not strictly regulate health-insurance pricing. For those reasons, McDonough all but said that the Massachusetts approach is not the best option for attacking the problem of the uninsured in Montana.

He also noted that Massachusetts previously underwent years of expanding government health insurance -- changes that Montana hasn't come close to making.

Just what types of health-care solutions may emerge from the Health Care Forum remain to be seen.

McGillen says Blue Cross wants to take information gleaned from the forum, put together a "working group" of insurance and health-care professionals and public officials and start advancing ideas to improve Montana's health-care system and coverage. Another forum is planned a year from now. By then, Blue Cross and others are hoping to look back and say, "Look what we've accomplished in a year," McGillen says.