Def not true with AWS, unless you reach a particular scale. Not for product market fit. My technology choices would be fully managed services so I could focus on my actual business.

Multi-region in AWS means building it yourself.

I suspect that the skills for real HA are atrophying because for 99% of the people multi-AZ is enough and most of the AWS stuff supports multi-az automagically.

The problem with multi-region is that it means configuration, and there are probably lots of services that you can't actually configure to be multi-region. Cognito is one off the top of my head. It looks like the various aurora flavors do multi-region, but what about Neptune? SQS? API Gateway? AWS Lambda? MediaLive?

Maybe you can hide all that behind DNS failover, maybe you can't.

Real multi-region is basically means going back to old-school HA, and that was hard to do when it was your data centers. On AWS it'll be even harder.

That isn't to say it's not possible, it's just a tremendous amount of work.

I mean really, if us-east-1 is down 80% of the internet is screwed...so from an expectations point of view does HA of your particular service matter if that happens? Even for a financial outages happen.

Once you have enough people it might be worth it. For a non mission critical startup? No fucking way.

Multi-AZ and then grow into multi-region if the need arises. Multi-region is a huge lift the moment all your data must live in two regions simultaneously. Very few shops are experienced enough to run clusters across datacenters in a way that can handle the unhappy paths.