YMMV, I run a startup that serves critical customer use cases, and from day 1 I had to care that my DB was HA, backed up, and could be restored. Actually had a case early on where we had to test this because I accidentally deleted customer data and had to restore - took all of one click, with no scripts, no prior investment into backup management etc. We also had to go through infosec reviews from day 1, and many of these are a must have. Doesn't matter if it's a small crew or large. Our customers care.

3 years fast forward with hundreds of customers, and we haven't had a need to hire someone full time to "manage" these services. This may/will change down the line, but I couldn't have built my business without one of these cloud vendors.

Edit: I also know the pain of building (and managing) this on bare metal (last company did that) - and it was just apache/php/mysql on bare metal. It was a mess