I dunno, really.  I am fortunate enough to have access to three commercial 
screen readers for Windows (Window-Eyes, Supernova and JAWS) as well as to NVDA 
and of course VoiceOver on the Mac, the latter of which just happens to be my 
primary combination.  I’m still not convinced that’s enough.  Certainly there 
does exist the potential for the Mac to have a third-party screen reader that 
sucks less than VoiceOver, and Windows accessibility is just fundamentally 
broken anyway by birth, but if Microsoft ever pulls its finger out—who knows, 
we may yet reconcile the need for working accessibility out of the box with a 
choice of multiple platforms, but I do worry that the commitment to (at least 
OS X’s) VoiceOver has not been as good as it could or should be, and if we 
_want_ to have just one choice of screen reader for every platform then we had 
better be ready to accept nothing less than perfect.  It would be a great 
disappointment to find that platforms with excellent out-of-box accessibility 
were hamstrung merely by internalised development processes and NIH politics, 
yet that seems to be the one true way with OS X and iOS, and also recently 
ChromeOS and Windows as well.  I consider Windows to be the more accessible 
platform at the moment, merely on the basis of application choices, but I use 
OS X because I prefer the model and quality of the accessibility that it 
provides.  This may change if Microsoft does a half-decent job with Narrator in 
Win10, or alternatively that my discontent with OS X in general and perhaps VO 
in particular simply drive me back to Windows for the better of the 
mediocrities.  MS are strongly hinting that they do not intend to replace AT, 
so this seems very likely.

JMO. :)

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