HJAR May/Jun 2026

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2026 11 be to standardize . . . At one time, I don’t know if this is true, there were more heart catheterizations in McAllen, Texas than anywhere else. And a lot of times you get a lot of procedures because of the reimbursement rule. I’m not a healthcare economist or anything like that, but the reimbursement rates have a lot to do with what tests get run and with how and why diseases get treated. There’s no doubt about it, the problem is everything is true, but you’re trying to un- ring a bell. And it’s depressing to think, but I hope I’m not right, but maybe the bell has already been rung that people who are born into poverty, and we know this would be a fact, have the greatest predictor of a child’s economic outcome, an economic position with their parents when a child is born. And I think that just gets more and more true. Editor Well, it doesn’t help when our hospitals are paid a lower rate. They don’t pay less for the equipment, but they’re paid a lower rate of reimbursement for a procedure. You can’t compete on a national level for that. Carville What that means is, if I’ma physician in Louisiana, if I get less reimbursement, I’m going to do more procedures. Editor Interesting. Capitalism at its best. Carville Yeah. I think there’s evidence that that’s true. Editor Let’s switch to something that I’ve found a little eye-opening and one of the very questions I’m so excited to ask you about. In a May 2025 press conference on drug pricing, Robert F. Kennedy, Jr. said, “The pharmaceutical industry paid Donald Trump a hundred million.” And RFK then argued that the president “could not be bought.” The president stood there shaking his head. James, there’s so much money going through politicians on both sides that nothing seems pure anymore. Not that it ever was, but peel back that curtain for us a bit. What is really hap- pening on the inside? Carville Well, I mean, big surprise, pharma is a huge presence in Washington. It’s a huge presence in the Washington Republican Party, also the Democratic Party. I mean, they play “the game” very, very effectively. And you have to ask somebody with bet- ter medical knowledge than I [have], but the kind of drugs that they want to invest in [are] not necessarily the drugs that peo- ple need the most. And the pharmaceuti- cal companies say, “We have to charge a lot because of research.” But we pay the most and a lot of the research goes on here. They pay less for a comparable drug in Canada because they can. They can charge more here. I mean, I’ve been around this for a long time, but basically, our healthcare is about 19% GDP, I’m just guessing. I don’t know if any other country rates 15. Editor So are the politicians just accepting the money and keeping it going? Where is this happening? Carville It’s happening everywhere. It’s happening in Washington. It’s happened in Baton Rouge. It’s happening in Little Rock. It’s happening in Austin. It’s happen- ing wherever you are. I mean, it’s a highly profitable industry that protects itself very effectively. Editor So I think COVID laid open the problem that we have with not making our own drugs over here. If we’re doing the majority of the research in the begin- ning, why in the world isn’t the U.S. gov- ernment making its own drugs? Carville Because the pharmaceutical com- panies are worth hundreds of billions — tril- lions of dollars. They're not going to give that up. It might be the way the world should operate, but it’s not the way that the world does operate. Editor But if they’re making that much money, our citizens could recoup that money and get tax breaks because we would be the ones making those drugs. Carville So how would you do that? A