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Actually, forget about the file output preset. It wouldn't work for posixmodule. > 80% of the entry points are #ifdef conditional on platform functionality. Which means the Clinic generated stuff needs to be #ifdef too.
It wouldn't be that hard to add the ability to #ifdef your generated code... but then what? Should it generate an #endif too, right before the end of the block?
If it closed the #ifdef, then it'd look dumb:
 /*[clinic input]*
 ifdef HAVE_WHATNOT
 os.whatnot
 [clinic start generated code]*/
 #ifdef HAVE_WHATNOT
 ...
 static PyObject *
 os_whatnot(PyModuleType *)
 #endif /* HAVE_WHATNOT */
 /*[clinic end generated code: output=... ]*/
 #ifdef HAVE_WHATNOT
 {
 ...
 }
 #endif /* HAVE_WHATNOT */
If it didn't close the #ifdef, well, that looks dumb too:
 /*[clinic input]*
 ifdef HAVE_WHATNOT
 os.whatnot
 [clinic start generated code]*/
 #ifdef HAVE_WHATNOT
 ...
 static PyObject *
 os_whatnot(PyModuleType *)
 /*[clinic end generated code: output=... ]*/
 {
 ...
 }
 #endif /* HAVE_WHATNOT */
though maybe that's less dumb.