Are the rules on the ward determined democratically, as Nurse Ratched claims? If not, who does set the rules? If they are, what keeps the men from creating rules that make them happier?

Nurse Ratched's democratic vote tally includes the Chronics, who have no real ability to make the rational choice required in a vote. This tactic ensures that Nurse Ratched can maintain the status quo whenever she wants, despite the obvious support for McMurphy among the Acutes.