There is plenty of bad code in startups too.

I am surprised they did not use CloudWatch logs in AWS. I am sure they are not the least cost log service but it simple to get logs in and out of it.

Hypothetically a hospital could have an embedded software development unit and they could work from a base of open source software. A challenge here is that a hospital is a social hierarchy in which a software developer without professional associations, unions, etc. might not be treated fairly by nurses, doctors, and other licensed practitioners.

I know more than one MD who decided to skip the hazing of residency and board certification and go into medical software development.

Healthcare in the US is not expensive. I am in Europe (Czechia), paying $3500 monthly while making $100k yearly before taxes and healthcare/social insurance deductions (over 48% of my income in total, and that's still low for Europe).

Healthcare in the US is relatively expensive for poorer people. That's it. It's not expensive in absolute terms. It's cheap for a programmer, any programmer in Europe (except Switzerland) is paying way more.

And don't get me started on the quality of care here, because you can't just compare costs 1:1... It's extremely bad. Even the worst options in the US are miles ahead. The healthcare providers here will treat you like the worst scum of earth.

That's from personal experience. I'll be moving to the US soon - healthcare is one of the big reasons.