A lot has changed since a former chairman of General Motors Corp. once declared, "What's good for GM is good for America." These days it might be more accurate to say, "What ails GM, ails America." And what's ailing GM, CEO G. Richard Wagoner Jr. recently told the Senate Special Committee on Aging, is the skyrocketing cost to employers to provide employees and retirees with healthcare.

But while that's a familiar tune to Congress and the nation at this point, Wagoner took the unusual step in his recent testimony of endorsing a possible course of action that emphasizes fitness, wellness and disease prevention programs. While acknowledging that there is no single solution for reducing costs and improving quality and outcomes, the GM chief executive outlined an approach that essentially would divide the problem for policymakers into potentially easier-to-address segments: First, there needs to be a plan for managing and cutting costs for the 1% of the population with chronic and serious illnesses that accounts for some 30% of total healthcare spending, and then second, there needs to be an approach to health policy for the remaining 99% that would essentially keep them healthier and less likely to tumble into the abyss in which the other 1% operates.

To be sure, the lens through which GM views healthcare is heavily tinted with the unique issues that a unionized workforce environment creates, and the notion, proposed by Wagoner, to create a reinsurance pool for the unhealthiest 1% is an idea not widely embraced by others in Corporate America. Even so, GM's effort to force Congress to grapple with a broader programmatic solution could elevate the healthcare policy debate and encourage companies to become more instrumental in developing a viable national policy, rather than lobbying for small tweaks in tax or insurance policy. "Any time that GM promotes anything, it becomes an important factor," says Michael J. Armstrong, a principal in PricewaterhouseCoopers' healthcare practice.

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