The msft cost is probably amost free. They like lockin that way, until you have everything, then you get to pay full price.
In health care the individual departments often buy their own PC's (and pay for support)
The sad part here is that Microsoft has convinced most of IT that going with all Microsoft stack is an 'IT strategy'. They have succesfully perverted the entire 'business strategy aligns wtih IT strategy' that IT has been working for the last few decades. I see no need for the CIO of this organization to be 'at the table' when major business decisions are being made. After all, the IT 'strategy' is already set, right? No need for updating of for any correlation to the business strategy, ever.
The clowns running this organization should be ashaed of themselves for making such a clueless statement. Then again, welcome to public healthcare....
Do some basic research on IT strategy (hint: look for a pyramid shaped thingy) and ask the masters how 'windows shop' aligns with Business goals? Watch them struggle with the basic concepts....