I looked at the cost of a Satellite Phone, and finally came to the conclusion that they cost more than I care to spend. I ended up buying an InReach from REI. They had a $50.00 rebate, pluse at REI you get 10% credit, so final cost was 175.00 plus tax. Not so much more than the Spot.
I was in front of the same decision and chose a sat phone a week ago. I went the other way, though.
The phone I bought (Isatphone Pro) cost me $485, and I have 2 years of prepaid service with 100 minutes for $142. My spot without tracking costs $198 for two years of basic service, so unless I get chatty, my running cost is lower than for that orange brick I have never had any use for.
The initial cost of the phone is significant, but I have been in situations that really asked for a phone while the 911 button on the Spot was clearly not within the threshold of the situation yet. Calling a doctor or nurse was what I needed, and texting isn't going to get me what I need in such a situation, although I can use the phone to send and receive texts for things like weather updates and other basic stuff to save airtime.
I'm taking the new phone to Isle Royale tomorrow - first test in the field, although nothing like the Sierras, where steep mountain faces to the southwest can keep the Inmarsat from locating the satellite it needs to talk to. If money was absolutely no issue, the Iridium phones with their low orbit satellite network are what I would choose, but the sticker shock for device and mostly the ridiculous prepaid costs was enough to go with the Insmarsat.