This is naive. I've been building an EMR in the healthcare space for 5 years now as part of an actual provider. We've incrementally released small chunks when they're ready. The codebase I've built is the most consistent codebase I've ever been a part of.
It's bureaucracy AND government process AND constantly changing priorities and regulations and requirements from insurance providers all wrapped up into one. And as such, we have to take our time.
Go and tell the clinicians currently using it that it's not useful. I'm sure they won't agree.
> Perfectly architected code vs code that does the thing have no real world difference
This just flat out isn't true. Just because YOU haven't experience it (and I think you're quite frankly telling on yourself with this) doesn't mean it doesn't exist at all.
> Because you yourself had to choose between time/opportunity vs your ideals and you chose wrong.
Like I said above, you're telling on yourself. I'm not saying I've never been in this situation, but I am saying that it's not the only way to build software.