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Sam Jayne / Axios

Marc Harrison — a doctor, bladder cancer survivor and CEO of Intermountain Healthcare in Salt Lake City — is less concerned about health care politics and more about what he and his colleagues can control: safety, quality and costs.

Intermountain is a not-for-profit system of hospitals and clinics throughout Utah, and it also owns a health insurance company, SelectHealth. It's like the Kaiser Permanente of Utah. Harrison chatted with me about a range of issues, from the "principles of insurance" to hospitals' reliance on having patients fill their beds. Read on for an edited and condensed version of our conversation.

What was your take on the Republican health care ideas that would have blown holes in the Affordable Care Act?

"We are concerned if some of the subsidies go away, we will see large numbers of people who will be functionally uninsured, and we believe that's a bad thing because they end up having to access much more expensive sources of care."

"We really believe in the principles of insurance. The idea that well people can hop in and out of insurance without significant penalties doesn't make sense. That's not how other kinds of insurance work. We need the herd effect so we can take care of each other while we're well so we get taken care of while we're sick."

Will Intermountain and SelectHealth stay in the ACA exchange?

"These are our patients. We're not going anywhere. We're going to keep trying to figure this out. We're making the best possible financial and clinical decisions we can, and we are not going to cut and run because we actually believe in population health and we believe in value. The exchanges, although imperfect, are a mechanism to help us exercise our muscles and get better at this."

Few, if any, reforms tackle the underlying cost structures in health care. What is the most effective way to lower health care spending growth?

"The process of measuring and being accountable has been good for patients. We've seen downward trends in number of hospital-acquired conditions and infections. I'm not sure that would've happened unless folks were held accountable...I'm biased, but there also is magic to a good health system that's married to a good not-for-profit health plan. But it isn't necessarily a closed model. There's room for other payers to play."

But not every hospital system can be an insurance carrier, right?

"It's about getting to real partnerships where risk is shared, and that's upside and downside risk. That's the only way organizations are going to get away from just turning the crank around volume."

Go deeper

Off the Rails

Episode 4: Trump turns on Barr

Photo illustration: Eniola Odetunde/Axios. Photos: Drew Angerer, Pool/Getty Images

Beginning on election night 2020 and continuing through his final days in office, Donald Trump unraveled and dragged America with him, to the point that his followers sacked the U.S. Capitol with two weeks left in his term. Axios takes you inside the collapse of a president with a special series.

Episode 4: Trump torches what is arguably the most consequential relationship in his Cabinet.

Attorney General Bill Barr stood behind a chair in the private dining room next to the Oval Office, looming over Donald Trump. The president sat at the head of the table. It was Dec. 1, nearly a month after the election, and Barr had some sharp advice to get off his chest. The president's theories about a stolen election, Barr told Trump, were "bullshit."

In photos: Protests outside fortified capitols draw only small groups

Armed members of the far-right extremist group the Boogaloo Bois near the Michigan Capitol Building in Lansing on Jan. 17. About 20 protesters showed up, AP notes. Photo: Seth Herald/AFP via Getty Images

Small groups of protesters gathered outside fortified statehouses across the U.S. over the weekend ahead of President-elect Joe Biden's inauguration Wednesday.

The big picture: Some protests attracted armed members of far-right extremist groups but there were no reports of clashes, as had been feared. The National Guard and law enforcement outnumbered demonstrators, as security was heightened around the U.S. to avoid a repeat of the Jan. 6 U.S. Capitol riots, per AP.

Felix Salmon, author of Capital
8 hours ago - World

China's economy grows 6.5% in Q4 as country rebounds from coronavirus

A technician installs and checks service robots to be be used for food and medicine delivery in Jiaxing, Zhejiang Province, China, on Sunday. Photo: Hu Xuejun/VCG via Getty Images

China's economy grew at a 6.5% pace in the final quarter of 2020, the national statistics bureau announced Monday local time, topping off a year in which it grew in three of four quarters and by 2.3% in total.

Why it matters: No other major economy managed positive growth in 2020. Although the COVID-19 pandemic was first detected in China, the country got the virus under control and became one of the main positive drivers of the global economy even as the rest of the world was largely under lockdown.

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