HJAR May/Jun 2026

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2026 13 Editor Let’s switch gears to private health insurance. Insurers are driven by profit. The public reaction to the UnitedHealth- care CEO’s killing — bullets report- edly engraved with “delay,” “deny,” and “depose” — surprised many who don’t understand the frustration people feel with insurance companies. These com- panies are doing what they are designed to do: generate returns for shareholders. But being on the receiving end of a denied procedure — even if it’s later overturned — can be agonizing. Healthcare feels dif- ferent than selling widgets for maximum profit. It feels like we’ve lost the human- ity in the system and brushed past the word “care.” When a person first encoun- ters someone asking how they will pay, it signals a priority. This isn’t done in most service settings. Do you think we’ve lost our humanity in healthcare? Carville Yeah, of course we have. Of course. Suppose you were driving down the inter- state and you saw a billboard and it says, “We insure everybody. Buy our stock.”Well, there’s no such thing. All right? I mean, yes. And the truth of that is a lot of places around the world don’t do it that way, but we’ve done it. The thing I guess I keep coming back to is I’m afraid we’ve already set our course here. All right? And it’s very difficult for me to see how it changes. I would love to be proven wrong. Editor Me too. There’s a growing argument that states should take more responsibil- ity for healthcare and that the federal gov- ernment 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 upWash- ington State, you’re going to have much bet- ter health outcomes. You grew up Missis- sippi, well — That’s not supposed to be the way, at least in my mind, the way the coun- try 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 peo- ple get healthcare: they get it through the employer, they get it through their govern- ment. 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 con- gressmen talk and they say, “We’re not doing it as well as these other countries.” But these other countries all have univer- sal healthcare and we seem to be commit- ted to keeping the powers that be [that] you talked about, in place, who are charg- ing 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 inter- esting 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 gro- cery store. Carville You can go to [any number of places] 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 health- care 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 Arkansas’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