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There are so many roads to go down in answering this question, none of them satisfactory. But, let’s follow two or three to see if something of value can be found. There is a qualifier here, and that is we have to understand the “they” in your question. “They” is not the White House. “They” is Congress, the ultimate board of directors for all things federal. The White House may lobby aggressively for privatization (though the Trump White House is backing off on that pledge), but in the end, dumping a Cabinet department—one of the very largest, with 150+ hospitals, hundreds of clinics, mobile clinics, VetCenters, and specialty care centers vital to the treatment and rehabilitation of wounded warriors—would come with massive congressional input and pushback, given that every state, and probably every voting district in the U.S. is linked in some way to veterans.Former Congressman John Linder (R-GA), a Vietnam-era veteran writing for The Hill this past January, made an oft-repeated, and undeniably passionate, personal, and compelling case for privatizing VA: “The VA should first commit to shortening the long lines waiting for the determination of eligibility for VA medical care. The government’s role in veterans’ care should then be focused entirely on matters that are the result of war. Traumatic brain injury, amputations, post-traumatic stress and the rehabilitation from those injuries are unique and special, and we should dedicate the entire medical resources of our government toward improving the lives of the wounded and their families.“Medicare needs reform as to reimbursement formulas and regulatory burdens,” Linder continued, “but it is the most patient-centric of all of our government healthcare programs. VA eligible vets should be enrolled in Medicare and allowed to make their own healthcare decisions. If that is privatizing VA healthcare, this old vet is for it.”Linder’s argument has a populist foundation—and, frankly, a pretty reasonable one if you’re the veteran or veteran family member in this situation—and that is there are many aging veterans (WW II are dying at the rate of 400 per day), and Cold War and Vietnam vets who aren’t far behind them who don’t enjoy urban or even suburban access to a VA hospital or clinic. There are many younger veterans suffering from traumatic brain injuries (TBI) or amputations or who are para- or quadriplegics for whom local access to VA specialized care is simply not an option—they have to look locally for care.Privatizing advocates in Congress, with Senator Bernie Sanders leading the way, pushed through legislation in 2014 allowing veterans to seek care from a private medical facility using the Choice Card, with reimbursement from the government if the nearest VA hospital is more than 40 miles away or the wait time for a closer VA hospital is over 30 days. In 2015, Senator John McCain (R-AZ) called for a permanent Choice Card that would have opened health care access anywhere, anytime, to all veterans. While that legislation languished, Donald Trump was elected and, just a few days ago, the President signed a bill to extend the current Choice program, closing financially-burdensome loopholes for veterans, but not fully implementing the McCain vision for private-care-for-all-vets.But VA isn’t just medical facilities: VA is benefits—the Veterans Benefits Administration, VBA—covering home loans, student loans, employment and training, insurance programs; While not statutorily a part of VA, the U.S. Court of Appeals for Veterans Claims in inextricably linked to veterans’ claims processes. VA is also cemeteries—unlike Arlington National Cemetery, which is operated by the Department of the Army and the Military District of Washington, VA’s vast inventory of final resting places for the nation’s veterans come under the services and supervision of the National Cemetery Administration (NCA). The Department of Veterans Affairs also shares special interests like veterans homelessness programs with other Cabinet Departments. There is also an Office of Tribal Government Relations within VA.Do the privatization advocates want benefits and cemeteries in their operations portfolios? Maybe benefits…but cemeteries, not likely; homelessness programs? Probably pass on that, too. So, if the question is appended to include “…privatized the VA healthcare system,” there is some room for a more detailed reply.Does the Congress have the will to support dismantling a 100-year-old system, multi-pronged system, employing nearly 300,000 people (voters), on a multi-billion dollar budget that benefits Congressional districts from Florida to Hawaii, and from Maine to California? Doing away with something as sacred as VA, even though it has significant flaws in its health care and benefits services, is asking a lot of a Congress that is reluctant to do much of anything of merit in the past two or three decades.Partial-privatization advocates like Linder suggest VA retain its core medical competencies—trauma care, prosthetics, and rehabilitation, for example—and open up the private care market to the balance of the nation’s 22 million veterans. But polls and research don’t bear out the need for such cherry-picking care. Veterans on the whole are not dissatisfied with their VA care and many veterans recognize that the stories of wait lists so long that veterans die before they are seen don’t represent the average veteran’s experience.But more than that is the problem of what I call “Records re-absorption” once a move to privatize VA got underway. It’s one thing for a major health care consortium (and it would have to be a consortium—no one healthcare organization has the total scope of abilities and resources to take over VA) to build a non-federal management structure to operate the medical side of VA.The nation’s largest healthcare corporations are familiar enough with the brick and mortar and management of hospitals to figure out how to operate the medical structures—the basics—currently operated by the federal government. What I don’t believe they have any proven track record on is transitioning a two-headed (VA and DoD) federally-created health care records over to a private heath care records’ management system which has to incorporate a veteran’s military medical records history as well.Even VA and the the Department of Defense haven’t arrived at an efficient record’s transfer system that allows for the seamless shifting of active-duty medical records to VA’s medical records databases. If you need evidence of that, just look at this partial list of speakers at the most recent (April 20–21, 2017) Military Electronic Health Care Conference in Washington, D. C.I. Achieving an Interoperable Electronic Health Record – Government & Military Needs, Programs and Opportunities“Not Everything is Computable: Archiving and Sharing the DoD Health Record”■ COL JOHN S. SCOTT, USAInformatics Policy Director, Health Affairs, Department of Defense, Office of the Assistant Secretary of Defense, Health Affairs, Uniformed Services University of the Health Sciences“MHS GENESIS: Driving Successful Business Transformation”■ DR. PAUL CORDTS, M.D.Director, Functional Champion, Military Health System, Defense Health Agency“Achieving Interoperability Among DoD, VA and Private Sector Partners”■ MR. LANCE SCOTTDefense Medical Information Exchange (DMIX)“Advancements in Health Data Interoperability and the Impact on the Veterans Benefits Management System”■ MR. THOMAS MURPHYPrincipal Deputy Under Secretary for Benefits, Department of Veterans Affairs Benefits Administration (VBA) and■ MR. BRAD HOUSTONDirector, Office of Business and Process Integration (VBA)“Interoperability 2020- Why Data Exchange is Not Enough”■ MR. KEN RUBINDirector of Standards and Interoperability, Veterans Affairs Health AdministrationI know some of these speakers, and they’ve been doing hard work in the vineyards of progress toward a seamless VA-DOD health records interoperability for years! In the 1980s, when I was on the staff of the House Veterans Affairs Committee, an Army general, a well-respected military physician, came to us with his idea for a medical identification card that would hold all a soldier’s (I’m using “soldier” to cover, generically and in a gender-neutral way, all branches of the military, rather than adding sailor, airman, marine, coastguardsman every time) active duty medical history. The card would stay with the soldier when he or she left the military and was eligible for VA care. The information on the card would then be “read” by the VA system, and all the appropriate boxes in the veteran’s VA medical history would be properly filled in with the previous active-duty history.A wonderful idea, and although it was about two decades ahead of its time in terms of chip storage and read/write capabilities, it should have been embraced and worked on. But neither our committee or the folks in the Pentagon could get enough energy behind the concept to really put the proper work into it. Despite come-to-God meetings in the Oval Office where more than one president has commanded the Secretaries of Defense and Veterans Affairs to get their act together and work together to come up with a joint-records-sharing plan, the real work has eluded both departments.The irony is that VA has a perfectly fine electronic records management system, one that is doctor-nurse-patient friendly, and completely transportable. During Hurricane Katrina, veterans who were evacuated from the New Orleans VA care area, had their health care records in place no matter where they went in escaping the storm’s path. That was 12 years ago. Even medical imaging records—X-Rays, CT scans, MRI’s—can be passed along to another VA Medical Center as needed.Look at the world of the private physician working through a private healthcare system. In all likelihood, they have a proprietary health records system that utilizes lap-tops, desktops, and a linked central server. My primary care physician and his practice are set up that way. If they are affiliated with a local hospital (and most are) or hospital system, they may have additional access protocols shared between their practice’s office and the hospital inpatient system’s. But that is not always the case.A doctor I spoke with in reference to this Quora answer, discussed the challenge of working with veterans’ health records.“I always look at hardcopies, paper printouts, of any records that they have brought with them,” he said, referring to new patients coming from the military. “If they have imaging,” he continued, “I look at the disks as well. There is absolutely no crossover between the military medical record system and ours. (my italics) Patients are often under the illusion that our system can directly access medical record systems at other practitioners offices, or even the hospital as well, but our systems have no such access.”With respect to the specialized coding system used by physicians—referred to as CPT and ICD 10—the physician I spoke with said, “As far as what coding system the military may use for their diagnoses and procedures, I would imagine that they use the same CPT terminology for procedures and ICD 10 as we do. But anything that came from anywhere else, military or otherwise, would have to be entered manually.” (my italics)Which should make anyone who supports privatizing VA healthcare think long and hard about re-absorbing veterans medical records into a privatized system when even VA and DoD haven’t been able to work out the transfer kinks. A lot of progress has been made, don’t get me wrong, but countless taxpayer dollars have been expended in the quest for records “jointness” and still more will be spent before anything approaching full transferability is achieved. Just because Amazon can deliver products to your doorstep by drone in under 30 minutes does not mean a similarly aggressive and consumer-savvy healthcare network will be able to deliver better healthcare to a veteran in anywhere near such a timely manner. The veteran healthcare learning curve will be exceedingly steep, and, I think, prohibitively expensive.A privatized VA healthcare system would, in my opinion, be a crippled and vision challenged beast from the very start. The private companies running it would not see anywhere near the profits they seek (or suggest to their stockholders); the veterans using it would, in all likelihood, have more, not fewer, time, records, and care obstacles placed in their way; veterans’ service organizations—like the VFW, the American Legion, the Disabled American Veterans and many other similarly chartered advocacy organizations—would lose much of their grip on VA; Congress would have to cede some authority (which it hates to do), and therefore would find new ways to meddle in the process; and non-veteran healthcare consumers would see their doctors’ offices filling up with veterans who, in all probability, would have “move-to-the-front-of-the-line privileges” as part of the privatization mandate, and that would never end well for either side.

As Anonymous points out, "secret waiting lists" and other such work-arounds are used in many private-business industries; they are used because meeting the standard directed is impossible given the resources with which to work. The resources provided are generally based upon some number comfortable to the bottom line, to profit-making ability, which is a number far divorced from the actual numbers needed to meet the standard- the two numbers are not even on speaking terms, usually. In the VA system, the number is one set by Congress- which has pretty much no clue what caring for veterans actually costs- they just are good at telling what number won't make their constituents squeal.I heard some Congress-critter interviewed about this today; he was absolutely incensed that the Director of the Phoenix VA hospital- who was also a physician- was paid $350,000 yearly. Absolutely incensed. Well, the average pay of a CEO of a large hospital runs around $500,000, so, to me, it would behoove the Congresscritter to defend the bargain we taxpayors are getting with this person's salary. The Critter was also ticked off that the Phoenix hospital's groundskeeping should cost so much- again, the Critter displays his ignorance: The complex is HUGE, and, while it's certainly true a spartan area of gravel over dirt with the few struggling trees' trunks painted white and roadways lined with white-coated rocks would look properly military, it would be even more torturous temperature-wise. Greenery in the desert isn't merely an affectation of plenty, but a temperature-reducer: surrounding a building with grass and trees in Phoenix can lower the building temperature as a whole by up to 15 degrees! Has he ever been to Phoenix?! Last time I was up there (last summer) it was 118 degrees outside- scorching!Why suggest setting the building in a hotter area is somehow "cost-effective"?There's the suggestion the reason the Phoenix VA hospital got caught using work-arounds is because of the fact many of its staff are unionized. Tell me, please, what evidence is there for this conclusion? "They're unionized, therefore, they cheat"? Is that it? An individual staff-person can't be held liable for performance because they're part of a union? Wrong again- if your supervisor has their ducks in a row, the documentation is there, you can lose your job for screwing up fast with or without a union. (I'm a little worried the calls for people's heads is taking precedence over the calls for fixing the problem).Unions and groundskeeping have a relationship to the bottom line problem, though, which is where the Congresscritter was going: The VA budget appears quite healthy on paper. $150 BILLION was requested for this year. Sounds like a very healthy budget.Except there are "hundreds" of VA hospitals and health clinics, AND this budget also includes:The benefits provided include disability compensation, pension, education, home loans, life insurance, vocational, rehabilitation, survivors’ benefits, medical benefits, and burial benefits.[9] The VA currently breaks down benefits in a benefits booklet.[10] Benefits and topics include; VA Health Care Benefits, Veterans with Service-Connected Disabilities, VA Pensions, Education and Training, Home Loan Guaranty, VA Life Insurance, Burial and Memorial Benefits, Reserve and National Guard, Special Groups of Veterans, Transition Assistance, Dependents and Survivors Health Care, Dependents and Survivors Benefits, Appeals of VA Claims Decisions, Military Medals and Records, and Other Federal Benefits.So how much of that healthy budget is actually going to the medical side, and how much elsewhere; just as how many of the 280,000 employees are in health care versus in all these other VA entities?Then there's the problem with contracting services and supplies: The Feds have a process which eats money and spits out the cheapest supplier- cheap supplies are not usually the best supplies- but, hey- anything for our boys and girls in uniform, right? It's gratifying to know we're paying the least amount possible to put these soldiers' lives back into some semblance of order.Edit: I meant to say this in the original answer, but missed it as I went along. The other problem is plain, old bureaucracy, and, while it's easy to say "Just revamp the system!" that not only takes a great deal of time and money-money-money, it also is diametrically opposite to the way large enterprises such as the VA work: We tax payors need to be able to see, step-by-step-by-step, exactly what happens to our tax dollars, to our service members, to our tax-paid employees, every little detail of the process must be tracked, marked, approved, pigeon-holed, overseen, filed, kept, for decades- and that is what makes the process bureaucratic. You cannot have- it simply does not work- such a large, detailed and varied organization as the VA without bureaucracy. Yet, it is that same bureaucracy which causes the problems seen. Why are there secret lists? Because the rules say a beneficiary must be given an appointment within 14 days of their request. Well, there aren't enough doctors and those doctors aren't invested in their job (they are paid well, but not as much as they could make in the civilian world) so, to make it appear as if the standard is being met, we give you an appointment for Oct 23, five months from now- the first available- and put your name, Mr Jones, on a piece of paper under the column October, Week 2, and then during the second week of October, we actually enter the appointment information into the computer so it looks as if your appointment wait time was only two weeks! Perfect!Why do we have to do it this way? Because there aren't enough doctors, technicians, diagnostic equipment slots, to meet the standard. Why not? Not enough money.Because is $150 BILLION really too high a price to pay for helping restore the life of any one who volunteered theirs in protection of ours?Edit, again: Another thing- this is about the doctors, themselves. Not all, probably not even most, but VA doctors do not have to be board certified. They don't have to be certified in any state, at all, in order to practice medicine for the VA. This leads to a certain number of doctors who gravitate to the VA system because... it's easier. It's... not as much work, not as- wide-open to exposing someone as a, possibly, poor/bad doctor. Sounds trite, but 50% of all doctors graduate at the bottom of their class, and, while practice certainly helps, where do such doctors get their practice- who wants them working on yourself or a loved one? The VA system is a good choice for such doctors.It's all about money- really and truly- it's money. If the VA had ever been funded correctly for more than a year or two, it would have the most superlative treatment facilities around, and our vets would be taken care of better than the rest of us plebes. But shortchanging veterans is easy; once they're back and we don't have to see their faces on the evening news, we say, "Thank you for your service" while crossing our fingers it won't be our son or daughter- and agitate again for having our taxes cut. We have smart bombs and drones- shouldn't the Defense budget be cut? We have SEALS- they can do anything in a rubber boat with some night vision goggles- why does this all cost so much? Isn't there some way to bring the cost down?We talk a good story, but like most things, once the immediate threat is over, we balk at paying for the damage we caused.Fund the VA medical side of the house correctly, instead of by some bottom-line number. And then, really consider why anyone would believe caring for our veterans the cheapest way is really the American Way.

It depends what you mean by “Work better”. If you think that decreasing the excess population is a good thing, and that there is no problem with letting the elderly die, the poor die, veterans die in poverty, those with CKD die, all while maximising shareholder profits, then yes.But the free market is not free in a heart attack situation. Instead they have you over a barrel; it is literally a matter of life and death. So they are incentivised to gouge you as much as possible because that’s what the market will bear. You can not walk away.And the situation is just as bad if there is only one major hospital in town and the next one is 50 miles away. Under the rules of the free market the hospital should jack up the pricing so that it’s just cheaper to go to your hospital than the one 50 miles away. And as for building a new hospital in a small town, forget about it. There’s not the business to sustain one, the capital investment is massive, and big businesses do form cartels - for evidence I present the map produced by Comcast and Time Warner to demonstrate why a merger wouldn’t undermine competition; because they’d already agreed to a cartel to undermine the competition themselves.And then if we are talking about zero government involvement and no subsidies, we’ve just done away with all medicines regulation. Bring back leechcraft. Bring back chalk tablets. How do you know that what’s in your medicine does any good at all?And the insanely bureaucratic US healthcare system just got a lot more bureaucratic. Yes, the private sector in healthcare is more bureaucratic than the public sector. This is because every single person employed by an insurance company is a bureaucrat. And it’s cheaper for the insurance companies to hire people to go line by line finding reasons to reject claims than it is for them to actually pay them. Meanwhile to protect themselves in the US medics need to take absurdly detailed records; according to one recent study doctors in the US spend literally two thirds of their time on paperwork.The US already spends far more than just about any other country on healthcare for results that are best described as mediocre. I do not understand this continual obsession with, instead of looking at what works in every other country but the US doubling down with the failed free market healthcare system that is the root cause of why the US system is so much more expensive and less cost effective than just about everywhere else in the world.