I definitely agree with you that the last thing I would want readers to take away from this article, is that they don't have to worry about accessibility or universal design. Until we have better tools, we should be providing the best possible experience with the tools we do have.

I also agree that we shouldn't be creating separate experiences for the blind. I think it's generally acknowledged that they end up being worse than a combined interface, never getting the resources or new features that experiences for sighted users get.

Where we seem to disagree is on the roll that screen readers play in limiting the usability of technology. On the one hand they are amazing because they provide access to technology that would otherwise not exist. On the other hand, by virtue of the way they function-mapping a 2 dimensional visual experience into a one dimensional stream of audio-using a screen reader can only be so efficient.

This lack of usability puts access to technology beyond the reach of many who are less tech savvy than you or I, and given that the vast majority of people losing their vision in the US are the elderly, there are a lot of people who fall into that category. What's worse, the rate of vision loss is set to double as baby-boomer's age out.

I totally agree that the medical-model of Accessibility sucks, but I think Screen Readers fall into that category. They seek to adapt an experience designed for others to the needs of the disabled. Conversational interfaces have the potential to create a consumer quality experience, that by it's very nature is accessible (at least to the blind). And accessible by default is the best possible outcome.