I'm not so sure Mike is using Voiceover (he's sighted with a blind
partner, if memory serves). However, I *have* used Voiceover (and will
again once I get a more modern Mac!) 

First thing to bear in mind:

Voiceover is definitely better than Narrator.

Second thing:

Voiceover has only been available for a couple years. I'd say it's at
least as good as Windows screen readers during a similar point in
their development, and as more MacOS applications use more of Apple's
development tools and embrace Cocoa, accessibility will do nothing but
improve. 

Third thing to keep in mind, and actually, it should probably be
first, is...

Forget everything you knew about accessing a Windows computer and
start as if you don't know anything. You can't ask the same questions
and expect to get reasonable answers. 

Now, I've said all that to say this. Accessibility on the Mac has a
long way to go before you can do absolutely anything on it. For
instance, I don't know of an accessible spreadsheet yet. However,
there is lots that it does well: there are a couple of accessible word
processors. ITunes is accessible now, they say, and vlc media player
works fantastic! So does Skype and Gizmo Project. The Safari Web
browser is pretty neat, too--you can actually get an idea of how a
Website is visually laid out as you read the screen, while still
having full and comprehensible access to that site. Can't do that with
the major players in the Windows screen reader market. 

I say you have to forget what you know about Windows because Voiceover
interacts with the OS in a far different manner. Also, while the key
combinations sound cumbersome, they really aren't, once you get used
to them for one, and get used to their logic for another. 
-- 
Buddy Brannan, KB5ELV
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