I know Scheme, I am currently learning Elm. I like picking up fun languages. I also like working with them when possible.
But I think the implication that a hospital board can confidently hire a developer that is "good", or one that will make good decisions in their behalf is wrong. For proof, see the OP of the thread.
Their decision, I believe, directly harms the hospital's interests. He has essentially become irreplaceable, because they don't have the necessary skill set to confidently hire someone who will be able to replace them. Even if, in the best of cases, OP leaves for a better paying/what have you job hiring someone to fill their void will be hard.
That's not what bothers me most, however. It's the attitude. It's us as developers going: "I picked the best tool for the job, and thus this solution will be intrinsically better for the business". Like we're doing them a favor.
We're not doing them a favor, even if the tool is superior for the use case the difficulty of finding other people who could take over you introduces an amount of risk that almost no business that understand the full implications would allow. Worst case scenario, the tool(s) might need to get re-written from scratch. And the new versions could have bugs the old ones don't, or poorly handle all the one million edge cases that pop up over time.
But the arrogance to say we are picking the best tool for the job, while really picking a tool we wish to use to satisfy ourselves intellectually is what bothers me. If you are forthright and say "Hey, using this will make me happier at my job. And I will thus presumably perform better, and I'm the person in the position to choose what we use" I think that's fair enough. Again, it's the conceit of looking at a business person in the face, and telling them that this tool is the best for the job, when it clearly isn't.
It might be the best tool to programatically encode the job. I can concede that. But I feel that is willful blindness on the part of us programmers to the needs of the business in the pursuit of serving ourselves.
And again, that bothers me. But you might say "Fair enough, and I was in the position to make that call, so I did". It's not like we exist to serve businesses. But to reiterate for the last time: To say this is being done because it is the best suited for the job at hand is wanting to have your cake, and eat it too.