It's not really that hard to change if you started with OFF, it just requires a logical dump and reload (typically on a replica, followed by some re-cloning and promotion). Companies with sizable data tend to have database engineers who can handle this fairly easily.
In any case, it's not an urgent maintenance operation like a VACUUM problem...
I look around now and you a right. It's really no big deal to move a few terabytes of data around but it sure was a mess back then and I'm once bitten, twice shy.
I was fortunate that the startup was willing to devote sufficient time and resources to help me get our DB problems under control -- including getting expert consulting services from Percona, attending conferences, etc. However I've definitely seen some other startups that didn't take DB tech debt seriously enough, and just kicked the can down the road until a major disaster occurred.
Anyway though, even aside from improvements in hardware and tooling, managing large DBs just gets less stressful once you've spent some time on the problem. Assuming you successfully solved this 6 years ago, why shy away from it in the future? You almost certainly learned a lot in the process, and the good news is it only gets easier from there!