I'm the sysadmin for a small nonprofit so my organization qualify for the $3500 yearly azure credits but the inability to set spending limits makes me not use azure. If I make a mistake or worse an admin account is compromised the azure bill is potentially infinite.
With azure I think you can mitigate the issue somewhat by having a superAdmin account without limits and set quotas for everything else but I still don't feel at ease with that.
My organization is a music festival so the infrastructure really has to work and not stop one day per year. I can keep an eye on everything during the festival and monitor spending. If things stop not during the festival people are a bit annoyed until I can look into the issue but nothing bad happens.
In a perfect world I'd like to have a way to setup a limit where you need to go through support to increase it. I'd really pay for that. I think it's really too easy to receive a nasty surprise bill.