HJBR May/Jun 2026

DIALOGUE 10 MAY / JUN 2026 I  HEALTHCARE JOURNAL OF BATON ROUGE upfront costs, and then you have to change human behavior. Editor It seems like in the school systems might be a good place to start. Feed them delicious, healthy food and they will develop good habits. Get rid of the vending machines. Carville The school lunch program is all tied into a gazillion other things, and the school board has to pay for it. So when I was in school, we actually had a vending machine, okay? But they had a six-ounce Coke bottle. Well, somebody drinking three six-ounce Cokes a week and somebody drinking three 32-ounce Cokes in a day, there’s all the difference in the world. Editor That’s true. Very true. Carville I mean, it’s not just what you eat, it’s how much you eat of it. Editor That’s true. Did you have cigarette machines too in your school? Carville I don’t think we had. I don’t recall cigarette machines in school. Anywhere else, but I mean, you couldn’t buy a lottery ticket in school. People are too short-term. Everybody thinks too short-term, but if you tell somebody you’re going to pay more today, 20 years later, you’re going to see a return, the politicians are just not going to do that. Editor So speaking of poverty, many southern hospitals — rural hospitals — are paid less by Medicare for the same procedure performed in places like Boston and Delaware because of the area wage index, something Congress controls, but poor states lack the votes to change it. It seems to me that this should be reversed, that states with worse health outcomes should receive more resources to fix the problem. Our hospitals will never be able to truly compete for top Carville Yes. Editor And the 30+ percentage of our children are now overweight or obese. But our children are under school guidance for most of the day. And are fed one, or in many cases, two meals a day. We’re also in charge of their exercise during that time. Why in the world aren’t we having better food for our children and keeping them healthier when we have control of them for so much of a day? Carville Well, the basic truth of the matter is processed foods are substantially cheaper than fresh food. Until you’re willing to spend money — and that’s just a fact. If you’re on a tight budget and a can of Vienna sausage is a lot cheaper than fresh produce or fruits or anything else — I think this is 95% driven by economic status. Editor I think it’s driven by our food that’s available to our citizens, and I guess my point is, we’re paying for it on the back end with chronic disease costs, but why aren’t we doing something more effectively for our children? Carville I understand. So if I went to somebody in [Louisiana] and said, “Look, we’re going to raise income tax from 6% to 12% and then we’re going to take that money and put it into providing fresh produce and fresh fruits for young people and families.” And believe me, 20 years down the road, you’re going to save money. That just doesn’t fly politically. Although, I’m sure it’s all true. Editor That seems to be the problem. We all know it’s true, but we can’t get it done politically because politicians are only running for the next campaign. Carville The problem is we have extremely high rates of poverty and poverty leads to just unbelievable consequences in expense. I mean, we just — we’re not very good at doing that, but it would be a lot of initial actually pretty good in the United States. And that’s because everybody has insurance. Editor Right. It makes sense. It is an unhealthy group, but they do have insurance. Carville Right. Editor It helps. And it’s paid for mostly by the government. Carville Yes. Editor Kind of interesting. Carville But we’re not going to get it for younger people, and it’s a shame. Editor Right now, Louisiana and Arkansas are consistently ranked near the bottom nationally in health outcomes. Life expectancy, chronic disease, maternal health. For this and other matrixes, Southern governors often compare [these states] with only other Southern states, not the U.S. as a whole. Some say this creates a continual race to the bottom. Maintaining mediocrity by telling citizens, “Things aren’t so bad.” This disparity has existed since the Civil War. Why can’t we shake it? Carville Well, we can’t because health outcomes are largely tied to poverty and both Louisiana andArkansas have very high poverty rates. If you just took the states with the highest amount of poverty — and also poverty goes a lot to diet — I mean, poverty leads to all kinds of terrible outcomes. That’s pretty clear. And for a bunch of historical reasons, Louisiana, even more so than Arkansas, I’m almost positive, is a high poverty state. Editor You look at that, and most of our chronic diseases, which cost us the most money, are tied to our food, as you say.