And, John, I apologize if I am being a smarta... I just can't help it.
No, I understand & I agree with the gist of what you said. However, I have no inside connection or skill to tell me who is a good IT person. And Dell and Microsoft will not want to take a crack at an AC problem, or an internet problem. So many of us, probably most of us, have had frustration with IT help, either cost or inability to fix the problem.
So that leaves at back at Dr. West's outcome. I think David said it well -- why spend $400 of patient time on $100 IT problem. And if the not very technologic Dr. West can dump off most of the tech stuff by using a cloud solution...well it makes sense for him. I suspect for many others as well.
As you referred to above, it's very tedious to install & reinstall every bug fix version. What if AC could work on the versions, and push out the solutions when I log on every day? Most of us can keep an internet connection going. And the rest goes away.