> hate to imagine how many startups out there don't even create indexes and just consider it to be a database problem and increase CPU/RAM

I've worked for a few of those fairly recently. I also worked for a place that was running on a fully custom codebase, no framework, php with all sql scattered through each page and all the devs using their individual machines to ssh into a central dev computer to work (tell people which file you're working on first). No version control of course.