> I'm surprised more mid-size companies - those with AWS bills in the 6-figure-per-month range - don't leave the cloud, get physical hardware, and pay some sysadmins.

I'm not surprised at all: that's thanks to the beauty of lock-in effects. Especially all those cloud-specific managed services make it really hard to switch, and even if you are treating the cloud as a pure VM platform, it is considerable work and risk to switch to a self-managed bare metal setup.

Basically, if you don't start bare-metal (incurring having to assemble the necessary know-how to do so) you will have a hard time to get clean from the cloud drug later on, when you think you're ready to afford having the know-how. I think this aspect has been a main driver behind the linked article.