HJBR May/Jun 2026

HEALTHCARE JOURNAL OF BATON ROUGE I  MAY / JUN 2026 15 Editor Me too. There’s a growing argument that states should take more responsibility for healthcare and that the federal government is stepping back from states like Louisiana or Arkansas. What would that actually mean in practice? Carville So what it means in practice is if you grew up in a wealthy state, if you grew up in Connecticut, then you’re going to have much better health outcomes than [if] you grew up in Louisiana. If you grow up Washington State, you’re going to have much better health outcomes. You grew up Mississippi, well — That’s not supposed to be the way, at least in my mind, the way the country operates — that people’s outcome in life shouldn’t be born in. Unfortunately, that’s become the way it works. Editor So you were active in the Clinton administration when a major healthcare reform effort failed. Looking back, what went wrong with that plan? Carville Look, you go back to how people get healthcare: they get it through the employer, they get it through their government. And for insurance, we attacked it on the employer base. And Truman tried, Nixon tried. I can’t think of all the people that did. Obama succeeded somewhat, and he did it through insurance. And when something fails, you always say, “Well, if I do it over again, I’d do it different.”I guess I would. But I’m not a healthcare expert. I didn’t design it, but it’s a shame in a country that people’s health outcomes are by and large affected by where they go, where they live. Editor W ell, it’s interesting to hear congressmen talk and they say, “We’re not doing it as well as these other countries.” But these other countries all have universal healthcare and we seem to be committed to keeping the powers that be [that] you talked about, in place, who are charging more for worse health outcomes. Carville We’re on a hamster wheel. We pay a higher percent of GDP for healthcare than almost anybody and our results — other than life expectancy after 65 — are mediocre at best. Editor And I think that has something to do with our food system, which is interesting because when you go to other countries, they’ll say, “American food, your portions are huge and the food is unhealthy. We wouldn’t dare eat like that.” They won’t even allow what we allow to be called food in their country. And they think it’s so disgusting [that] we eat like this. I wonder if they have better quality food for their citizens because they do cover their healthcare costs. So, they have an incentive to keep their citizens healthy. Carville People, if they want to, can eat fairly healthy in the United States. It’s a little more expensive, but we’re not struggling because of a lack of produce. The food is available. I think what happens is people get hooked. There’s something addictive about these ultra-processed foods, and the companies know it — they just keep producing more. I mean, why would anybody eat Velveeta when you can get real cheese? Why do people drink soda instead of fresh-squeezed juice? A lot of it comes down to cost and habit. But it’s not that healthier food isn’t there — it is. Editor But in portions of the South, you don’t have organic options in the grocery store. Carville You can go to Rouses and get any kind of vegetable you want. You can go to any number of places. We have delicious produce, particularly coming up this time of year, and people just choose not to eat it. Editor Do you believe the current healthcare system reflects the will of the voters or the importance of institutions with the most financial problems? Carville I think the voter and the politician have a very short-term outlook on things. And unfortunately, I think that’s unlikely to change. I hope — I would love to be proven wrong. Editor If you were advising Louisiana's governor tomorrow and could implement three changes to improve the health of the state over the next decade, what would they be? Carville To try to change the state budget [to] 2.5% every year toward prevention as opposed to treatment. A slow, slow turn with more emphasis on prevention. I would really, really push teaching nutrition in schools and I would put more money in school lunch programs that emphasize more nutrition. You’d obviously continue promoting healthy lifestyles. But my main position would be to try to shift resources gradually away from treatment and toward prevention. Editor Do you believe the financial burden of healthcare on the middle class and America is sustainable? Carville Well, anything is sustainable if it doesn’t change — but you’re going to continue to have poor outcomes. It starts with educating voters to understand that prevention actually saves money over time — a lot of money. You hear some people say, “Well, if people die young, that reduces the burden on government.” I don’t buy that. I hope I don’t. The truth is, the best way to treat disease is to prevent it from happening in the first place. Editor I agree. You’re not wearing your LSU gear anymore? Carville Well, I don’t like the direction that they’re going. I think that LSU was on a road, was committed to excellence. I think Bill Tate was moving us in a fundamentally correct direction. And I think that LSU’s