Those fuckers are well aware of their captive markets and extract rent like no other. The licensing costs on such an outdated piece of technology are obscene.
They're in "good" company. Do you think its less obscene to pay the horrendous license costs to companies like Oracle or SAP?
Anyway, I'm talking about the technology, which btw. has established open source alternatives. I once had an argument with the main person in charge of hospital IT, and he made it clear that he didn't want to risk his good sleep by using technology from non-mainstream suppliers, no matter what the cost. As long as we allow such people to value their personal sleep quality over the cost to the health care system, we need not complain about the consequences.
If you don't depend on the MUMPS/ANSI-M language or don't have to be backwards compatible, a lot more alternatives with similar features are available, e.g. https://github.com/facebook/rocksdb run behind e.g. Node.js.