UCSF is San Francisco's largest employer, UPMC is Pittsburgh's largest employer, UMMC for Baltimore, ... They are a complex web of entities, inexorably linked t

UCSF is San Francisco's largest employer, UPMC is Pittsburgh's largest employer, UMMC for Baltimore, ... They are a complex web of entities, inexorably linked to the government in each community. A plurality of middle to upper income people work for the hospital-educational-state system, and a plurality of middle to upper income people living there use its services. It gets a mix of funding from governments and private payers, but for some of those people, their income is from UPMC. They might not be monopolies, they might not be nationalized, but functionally, they are like really effective monopolized community corporations. Think about it from the other side: define nationalized corporation. What would make it last a long time? What would make it provide services effectively and competitive against imported goods and services? You get something that looks like university hospital systems, state university education systems, the real estate lobby, etc. Nationalization in some reductionist sense doesn't work in the US for these industries because of the open market we live in - you can, after all, drive to another place for medicine and educations, and many people do. But the levers that are used to incentivize people to choose their local semi-private provider, and the way the communities are themselves employed / derive income from the provider, is holistically nationalization.