And then there's the old joke.... "The best camera is the one you have with you". If a talented photographer goes out into the world with a smartphone, he or she will come back home with some amazing images. If he or she steps up to a Nikon D800 or D810, he or she will come back with some amazing pictures. If he or she steps up to medium format digital... you guessed it, some amazing images will be achieved.
Are there technical distinctions between these imaging options that lead to different aesthetic results? For sure. Is one better suited in some circumstances over another? For sure. But much of the format justification I see published in the literature is not based on any of these factors. There is a subtle undertone that means it is based on individuality and exclusivity, ie. "I own a rare camera system, and that makes my images different than what other photographers can achieve". Rarity might come because of the high cost of the particular camera, but rarity might also come, albeit fleetingly, because the camera is very new on the market.
In my own day-to-day existence, I've never run into another photographer shooting with a medium format digital camera system. I see Youtube videos and Phase One promo videos about these folks, but I've never run into one in real life. Come to think of it, I've never run into another photographer shooting with a Nikon D800 or a Sony A7r. By the time you fork out a few grand for a camera, you are in a rarified atmosphere indeed. Enough said.