My Father works as an engineer for the VA, the hidden costs of this transition is the need to rewire almost the entire VA hospital system to comply with cerner networking requirements at the cost of $100's of millions per hospital before the software can begin to be deployed.

The other hidden cost is that these ancient software systems are extremely efficient in terms of cpu / memory utilization compared to modern equivalents so the hardware requirements go up considerably which impacts power / energy efficiency and direct deployment costs for replacement systems. Not saying modernization is not a win in the long term but there are direct and indirect costs with these big transitions.

I wouldn't be surprised if Amazon is a national security component now and that may be why they don't pay taxes are get have deliveries subsidized etc. Can the government let them fail if they are critical infrastructure?