(Privileges are still limited by seccomp filters blocking some syscalls, and there's SELinux to block some other stuff, but it's still the actual root user without user namespaces, I think?)
Confinement still leverages dropping some root caps, seccomp, various other namespaces, etc.
People still should use user namespaces (and tools like Podman and Incus do by default) but basic stuff like that is not the reason.
https://stackoverflow.com/questions/33013539/docker-loading-...
Not sure about running rootful though. I don't really use rootful containers personally.
While there is a feature to do with UID mapping, it doesn't actually work/isn't usable/nobody uses it in current docker iirc.
Therefore root in the container very much is root on the host.