HJAR May/Jun 2026

8 MAY / JUN 2026 I  HEALTHCARE JOURNAL OF ARKANSAS The Politics of Healthcare Editor’s Note: When the boy from Hope was in the thick of the 1992 presidential campaign, his political strategist, James Carville, wrote three rules for the campaign staff in Little Rock: CHANGE vs. MORE OF THE SAME THE ECONOMY, STUPID DON’T FORGET HEALTH CARE Bill Clinton used them masterfully, especially the one on the economy. Carville’s role in that win — and, shall we say, his “colorfulness” — placed him in the annals of American politics as a master strategist. His marriage to Republican strategist Mary Matalin showed a depth and dimension that surprised many. Love him or hate him — and I’ve probably done both — few understand the inner workings of Washington as well as he does. That makes him a useful guide to one of Washington’s most enduring failures: healthcare reform. We wanted his insight on the politics of healthcare. From my perspective of following congressional and policy conjecture on healthcare over the years and peeling back the layers of a system with the very word “care” in it, I’ve been struck by how often our leaders acknowledge the same truths: the system is broken; Americans are sicker than people in other developed nations; we pay far more for healthcare and often get worse outcomes. And yet, meaningful change remains elusive because of the power of profits, not because there isn’t a road map. Hoping for change may work for a boy from Hope, but real change requires vision, strength, and fortitude. We can do better. With that in mind, we asked Carville for his perspective. I hope you enjoy the conversation. One on One with James Carville