HJBR May/Jun 2026

HEALTHCARE JOURNAL OF BATON ROUGE I  MAY / JUN 2026 9 Dianne Hartley, Editor Thank you for taking time to meet today, James. I was listening to a colorful podcast you did several weeks ago where you mentioned healthcare. With you being a Southerner with deep Arkansas ties, and having such an insider’s view of the federal government, we thought your perspective would not only be interesting, but actually may help to move the needle of the health of our citizens. President Donald Trump warned, “A whole civilization will die tonight, never to be brought back again. I don’t want that to happen, but it probably will.” Is this good for health or mental health of anyone? James Carville Is destroying a civilization good for health? Editor Well, that goes without saying. How about the mental health of Americans listening to this? Carville I mean, think about it from the perspective of a seven-year-old or a nine- year-old that says, “Well, mama or daddy, what does it mean he’s going to obliterate an entire civilization?” It’s just insane. I mean, I’ve never heard a president talk about obliterating a whole civilization. I don’t know what that means and I don’t know what the effect of that would be on a nine- year-old child. I don’t know what to say. Editor Me either. Well, I’d like to switch gears to public health and our U.S. healthcare system, which is almost 20% of GDP. Do you think that healthcare is a right or a privilege? Carville Well, if you think about the GDP in a country, it’s hard to think of people having diabetes that can’t get healthcare, but it happens all the time. I mean, we’ve made strides. I think that the truth of that is we’re pretty good at people 65 and over, and we’re terrible at people 15 and younger. I think that’s what statistics even bear out. Editor S o I spent some time recently in France and one of the things I noticed is that their people are not stressed about healthcare because it’s considered a right of the citizens. We all know, and so do our elected officials, that we pay more for U.S. healthcare and have worse outcomes. Yet we hold on to the capitalistic side of the healthcare system with a death grip even at our citizens’ peril. Why is that? Carville Well, if you were designing a healthcare system from scratch, you would never design what we have. But the truth of the matter is that we’re not designing it from scratch. And there’s only three places that pay for healthcare: insurance, the government, or you pay for it yourself. And everybody has tried it . . . and you’ve got to make a distinction between health insurance and healthcare, or the ability to pay for it. I don’t think anyone would design this system, having tried to change it back in the ’90s, and seen other people try it — it changed somewhat under President Obama. It’s very traumatic. And the problem is that it’s unaffordable to most people. I mean, a huge percentage of Americans feel like they are a disease away from bankruptcy. An affluent person looks at his 401(k) and looks at his cardiac scan sees it differently than a person who’s not affluent. It could be the same scan read- ing but for one person healthcare destroys them. And you got to look at it from the standpoint of the other person. Editor So why do you think healthcare can’t be a right of citizens? Carville So if you made healthcare a right, and every person has a right to healthcare, it would be staggeringly expensive. And right now we’re sitting on a $40 trillion debt. As much as I philosophically would agree with it, I just don’t think it’s a political possibility. Editor It would be more expensive than it is now? I mean, what middle class is paying for insurance is staggering. Carville We spend a higher percent of our GDP than most any other country, but where you are, you’re not where you wish you would be. And if you ask me, “Would I like to see that everybody has health insurance?”Yes. I mean, I’ve seen instances in my own family and seen it where you have some horrific thing that costs hundreds of thousands of dollars. That’s not terribly uncommon, unfortunately. And most people in the first world don’t pay for health insurance. I mean, they pay for it in taxes, they pay for it in other things, but if they have a really expensive disease to treat, they don’t worry about it. If they break their leg in five places, you don’t worry about the [payment]. You worry about the pain and when can you get back and walk. But, yes, it’s a hell of a burden on people, but I don’t see it changing. Editor So I understand that the UK changed it, and I think the quote was something like they had to pay their doctors off in gold. It was expensive to them to pay their doctors. Carville How long ago did the UK establish it? Editor It was after World War II. Carville Okay. That was Clement Attlee, right? It was a gazillion times cheaper then, and it was very painful then to do it. It’s just not going to happen today. I wish it [would]. I wish Harry Truman was successful. I wish all of the people that tried before were successful. People saw it, but we did do Medicare. And for the longest time — it might still be true — I think life expectancy at 65 in the United States is one of the highest in the world. The reason is — Editor I think it’s actually dropping a little bit compared to others — Carville Well, it might be. I mean, this was some years ago, but I bet you relative to the rest of the world, healthcare after 65 is