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It happens in a few ways. First, by examining the sourcecode when available. However, blind programmers talented enough to do this generally have paid, closed source work they're busy with. Second, when a platform has accessibility API's, it's at least easy to get the outline of a system, and determine what's not working. Third, of course, commercial grants for paid work. In the case of Windows, many corporations pay a lot of money to make sure Windows is accessible, so it can be used in schools, governments, and workplaces. This kind of money just hasn't been invested in the Linux desktop ecosystem. As well, in a centralized closed-source system, it's easier to force everyone to follow various coding requirements. In the case of Linux, who has the power to push through the infrastructural changes we're talking about? Oracle/Gnome, I guess? But there's a bunch of work the distros also need to do. Unlike in Apple or Microsoft, it's not just a matter of getting the "CEO of Linux" (not a real position) convinced that accessibility matters and she should invest in it.
Very true.