I guess that might be true also, to some extent. I guess most of the times I've seen something "messy" in software design, it's almost always about domain code being made overly complicated compared to what it has to do, and almost never about "how does this domain data gets written/read to/from a database", although it's very common. Although of course storage/persistence isn't non-essential, just less common problem than the typical design/architecture spaghetti I encounter.

I'm a firm believer in always using an auto-generated surrogate key for the PK because domain PKs always eventually become a pain point. The problem is that doing so does real damage to the ergonomics of the DB.

This is why I fundamentally find SQL too conservative and outdated. There are obvious patterns for cross-cutting concerns that would mitigate things like this but enterprise SQL products like Oracle and MS are awful at providing ways to do these reusable cross-cutting concerns consistently.