Historical institutionalism shows that health systems are rarely designed from scratch; they reflect deep-seated political compromises. Otto von Bismarck instituted social insurance in 1883 to defuse socialist agitation and bind workers to the imperial state. William Beveridge designed his 1942 blueprint during wartime solidarity to banish social squalor. Once these administrative infrastructures are built, path dependency makes radical transition nearly impossible, forcing modern reforms to work within existing bureaucratic channels.