I've had no trouble plugging in random PCIe or USB devices and getting <6ms buffers. Everything works fine. After some years deeply enjoying JACK's incredible flexibility & latency, I eventually switched to PulseAudio with mostly stock config but much reduced buffers.
Now a days PipeWire is the best of both worlds. It'd be interesting to see if the top post still had such issues as they do under PipeWire, although I'm unsure what about pipewires scheduling would have better mechanistic sympathy.
Plenty of distros do offer -rt kernels. But -rt has been a massive set of patches for a long long time, and it's a different operating mode, and it has tradeoffs. Extreme latency sensitivity is a niche need, and giving it to everyone would have negative impacts. That's why it's not the default. Good news though, -rt's longkng effort to upstream appears to be nearing a successful conclusion, so realtime may be a Kconfig away in the future. We just have to solve printk() first, ha! https://lwn.net/Articles/951337/