Fatalism isn't much of an argument. Meanwhile: what's the distinction you're making to keep Medicare and Medicaid out of the discussion?

Fatalism isn't much of an argument, but neither is, "I like nationalization, so I haven't thought about alternatives, and I don't think other existing federally-run health services provide any evidence about how a nationalized system might really turn out."

It is if it seems to be the result of a service. Don't really have any experience with Medicare / Medicaid and they don't operate their own hospitals / clinics. I do have experience(s) with IHS.

I don't --- does anybody? --- advocate for the nationalization of health providers.

In the countries held up as examples for nationalization -- UK, France, Canada -- aren't almost all providers now government employees?

If there's essentially only one payer, and even the terms of every transaction outside that one payer are dictated by national legislation, then the 'fig leaf' that the providers are nominally independent isn't worth much.