> Call me grumpy and sleep deprived, but every year I look at this talk again, and every year I wonder... "now, what" ? What am I supposed to do, as a programmer, to change this sad state of things ?

That depends on your goals. If you are into building systems for selling them (or production), then you are bound by the business model (platform vs library) and use cases (to make money). Otherwise, you are more limited in time.

To think more realistically about reality you have to work with, take a look at https://www.youtube.com/watch?v=Cum5uN2634o about types of (software) systems (decay), then decide what you would like to simplify and what you are willing to invest. If you want to properly fix stuff, unfortunately often you have to first properly (formally) specify the current system(s) (design space) to use it as (test,etc) reference for (partial) replacement/improvement/extension system(s).

What these type of lectures usually skip over (as the essentials) are the involved complexity, solution trade-offs and interoperability for meaningful use cases with current hw/sw/tools.