Re: Uncle! Yosemite it is, then.

QT implements (all be it poorly) some accessibility APIs.  Even mac has this requirement.  You are getting nothing additional on Mac in terms of more accessibility by magically doing something; the difference is that the app pool is smaller and most people use the built-in stuff.
You could probably get GTK via screen scraping, though.  And I think the screen readers that work with QT are the ones that ignore all the extra information it is supposed to expose but then manages to get wrong or not implement.
Also, I'm not saying that tab is a "good" navigation methodology, but Voiceover's is worse.  Flat representations work better in most cases, especially when the app provides keystrokes to get to stuff.  NVDA provides object nav, which is Voiceover for all intents.  Even Jaws provides the functionality, but it's more hidden there.  I think you haven't actually given Windows enough of a chance; you have deci ded to hate it, and therefore nothing any of us can say will sway you.  I tried OS X for a couple months before forming my final opinions, and if someone actually provided a good reason or a "actually there was a significant change" I'd revisit it.
I am not addicted to speed, if you will.  Nevertheless, if I wish to be competitive, I need to be as fast as someone with a mouse wherever possible.  OS X does not deliver this.  Windows does.  You are losing a great deal of time by deciding that fast is not important; I have seen this mistake a lot.  I will never have the advantage of being able to take in the screen at a glance, but I will have the additional advantage that my Windows screen reader responds instantly in most cases and that Windows philosophy seems to be "a shortcut for everything including important navigation."
I could be on the app store if I wanted.  The methodology is simple.  Use ssh from a Windows VM with Fusion, use xcode-build to build and run the app on the iPhone, and use Xcode for the parts where I have to add new files.  Alternatively, purchase Ruby Motion; this hides Xcode away entirely.  Saying that there are blind people on the app store (which I've never heard of before, do you have a source?) does not guarantee they did their development on a Mac.
As for VS projects: any development I do that requires a VS project doesn't anymore because I transferred to Cmake; if I need a VS project version, I just ask CMake nicely.  Anything cross-platform shouldn't.  The only time you need to hand-manage a VS project is if you need WPF or WinRT.
Python: if you haven't learned a "modern" high level language, you should.  Doesn't need to be Python, but something besides C/C++ (which I believe are your primaries) will open up whole new vistas for writing quick one-off things or smaller programs.  I s till think the accessibility point is important, however; properly indenting is important for inter-op with the sighted and also embeds the brace count right into the program source.  Braille is too slow for this: my synth is 800+ words a minute but my braille display has a world record of 165 words a minute as far as I can find.  Nevertheless, I consider not wanting to learn a programming language to be a dangerous attitude as a programmer-learn it and then hate it, fine, but don't not learn it.
As for the server vs home computer point.  Python and the Python web frameworks all run on my box with no extra configuration.  Node.js runs on my box with no extra configuration.  Apache can be set up in an hour or two.  PostgreSQL runs on my box with no extra configuration, just run the installer (there's a small accessibility pain point, use NVDA OCR as I recall).  Everything else can get a VM and WinSCP configured to use my much more pro ductive Windows editor, or I can just WinSCP my VPS.
As for Firefox lag, that's atypical.  Do you have an older box?  A lot of your complaints are things I used to see with my machines from before 2012, but since then I've barely done any configuration after a fresh install of Windows.  Avoiding OEMs may also be helpful in this regard, but nevertheless.  NVDA itself is snappy, though I will admit there is some startup time on Firefox these days.  I'm now wondering if you last tried NVDA with an out of date version-I can't remember the last time it wasn't snappy save on pages that do very nasty things with JS.
And finally, Espeak.  It's not about likes or dislikes.  It's solely about training to it mentally.  When I first switched to NVDA, I didn't want to use the Eloquence add-on for reasons which now seem silly, so I put up with the o god my ears for about a week.  And then i installed it because I realized I was being silly, and Eloquence had gained enough of the properties that I used to attribute to Espeak that I didn't go back.  At this point, I see it pretty heavily: switching synths is a complete mental reset for a half hour or so, though I'd say my ability to understand them in general has increased because I have long-term experience with two.  The only reason I consider Espeak better than Eloquence is because I see Espeak as having a future whereas Eloquence seems to be slowly dying--it'll get some revivals, sure, but no one can easily get their hands on it save the screen readers, and no one can open source it legally.

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