So only part of that gets "bloated" is Win32 API itself (which is spread across multiple DLLs and don't actually bloat RAM usage). Most of the time even those functions and structures are carefully designed to have some future-proofness but it is usual to see APIs like CreateFile, CreateFile2, CreateFile3. Internally the earlier versions are upgraded to call the latest version. So not so much bloating there either.
When the C runtime and the OS system calls are combined into the single binary like POSIX, it creates the ABI hell we're in with the modern Unix-likes. Either the OSes have to regularly break the C ABI compatibility for the updates or we have to live with terrible implementations.
GNU libc and Linux combo is particularly bad. On GNU/Linux (or any other current libc replacements), the dynamic loading is also provided by the C library. This makes "forever" binary file compatibility particularly tricky to achieve. Glibc broke certain games / Steam by removing some parts of their ELF implementation: https://sourceware.org/bugzilla/show_bug.cgi?id=32653 . They backed due to huge backlash from the community.
If "the year of Linux desktop" would ever happen, they need to either do an Android and change the definition of what a software package is, or split Glibc into 3 parts: syscalls, dynamic loader and the actual C library.
PS: There is actually a catch to your " C runtime is optional." argument. Microsoft still intentionally holds back the ability of compiling native ABI Windows programs without Visual Studio.
The structured exception handlers (equivalent of Windows for SIGILL, SIGBUS etc.. not for SIGINT or SIGTERM though) are populated by the object files from the C runtime libraries (called VCRuntime/VCStartup). So it is actually not possible to have official Windows binaries without MSVC or any other C runtime like Mingw-64 that provides those symbols. It looks like some developers in Microsoft wanted to open-source VCRuntime / VCStartup but it was ~vetoed~ not fully approved by some people: https://github.com/microsoft/STL/issues/4560#issuecomment-23... , https://www.reddit.com/r/cpp/comments/1l8mqlv/is_msvc_ever_g...