Why do you think sick systems are highly competitively fit? They seem to get a lot of work out of people, but also waste a great deal of it.
If your hypothesis is that sick systems must be competitively fit because there are a great many of them, I think stronger evidence is needed.
As long as the system extracts & uses more work than it's equivalent healthy system - after wastage - then it will outperform it. It doesn't matter if the system burns through employees every few years, there are plenty of other employees to burn up.
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