Um, the Indian Health Service is already privatized.  It is called Tribal Self Governance. It is both good and bad and it can be ugly.  The Bad is - there is very little transparency or oversight.  The books are closed.  No open meetings laws apply.  Executives are paid according to what their Board feels like paying them - not the federal pay scale.  For the ugly, check out the ADN story on the new federal lawsuit between SouthCentral Foundation and ANTHC.  Something is very very fishy.  Rotten.  Stinky.