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.

Cloud did bring with it the ability to quickly terminate an instance and no longer be billed for it. Renting equipment meant that equipment was your expense whether it was being used or not. So many people focus on cloud allowing one to scale up quickly, but to me being allowed to scale down just as quickly was the changer. Think of your local Target with 40 lanes of check out but with only 4 lanes open until the holidays where all 40 are open. During the remaining 10 months, they are stuck with unused square footage. That's what lease gear in your colo looks like to the bottom line.