Cloud didn’t suddenly invent renting servers in a data center. More importantly capex vs opex is generally in favor of Capex for stable companies like Hospitals. Middlemen always want their cut so you pay the full lifetime cost, plus transaction costs, and on top of that profit for those companies.
> The hard truth is that self-hosting only brings in meaningful improvements in cost if your operation grows beyond a certain scale
What nonsense, I’ve seen many small projects with ~500/month in hosting costs including manpower lose tons of money by trying to go with cloud services. Self hosting scales down ridiculously far because you need talent but your server guy can do other things when they don’t need to mess with servers for months on end.