I investigate the feasibility of completely privatizing prison physical and mental health service. The study is based on bid documents from Michigan’s 2012 exploration of privatized health care, along with historical documents. Five lessons are reported: (1) Price differences are largely attributable to staffing strategies, with private agents using fewer full-time equivalent (FTE) and less-qualified staff; (2) privatization ushers in personnel practice that is less structured for long-term employee retention; (3) managed competition is impractical due to qualified provider scarcity and desirability of client-patient continuity; (4) tension between best practice medicine and the profit motive is unresolvable, which necessitates diligent monitoring; and (5) privatization ideology is a powerful force that is external to the public interest but one that can be challenged by “good government” coalitions.