It doesn't, but it does.

We all know small businesses don't care about code quality. Ditto that best practices take a long time to trickle down from ivory towers to business, academia, to bootcamps.

Companies pushing the status quo tend to cluster. Poster probably shouldn't have picked on the midwest, it could be anywhere outside "cutting-edge" software centers.

This pushing of best practices you speak of is clustering especially in the geographic area where the norm is frequent job-hopping (before you fully reap what your practices sow), and where many also celebrate "move fast, and break things" during each employment stopover?

Yes, almost all of these companies are still doing better than the IT shops I remember from the 90's.

The "Joel Test" was a thing, for a reason.

If you heard about all of the bad code at Twitter pre-IPO, large companies don’t care about code quality either.

Startups are a bit different in that it doesn’t make sense to pay down most debt until a profit stream is found.

Or until they convince someone to acquire them or convince the public markets to give them money and remain unprofitable.