Yes,
some people can rent a truck (also, I don't think it's $20 in real life; probably $50 minimum, my real guess would be more like $70-$100 when all is said and done). You need any or all of a valid in-state driver's license, your own insurance, a good idea that it'll only take you an hour to find a good couch so that your money isn't wasted on a truck rental and/or a hope that the garage sale that has a good, affordable couch will be willing to hold it until you get back with a truck,
and, perhaps most significant, is that you need people to help you load and unload it. (Yes, yes, I know that in many parts of the country you can hire the Mexicans loitering in front of Home Depot for $5/head/hour, but that adds more expense and is possibly much riskier, since you're letting those people know where you live, know that you live alone or at least don't have sufficient help to move your own couch in, and know what kind of stuff is in your dwelling space. The furniture store delivery guy learns all of this too, but he's much better documented and therefore probably easier to track down if things go wrong.) You'd also have to hope that the couch remains in good condition for a reasonable length of time, whereas most RTO places will have some kind of recourse if you get a lemon.
Yes, it's true that it's probably possible to get a couch without going through a RTO contract if you have the money to make RTO payments. That doesn't mean it's reasonable, plausible, or even just worth all the extra effort. If you need a couch now and can pay it off a few payments down the road, it's not so bad to be willing to pay a substantial expense for that convenience. As long as the consumer is informed, there's no reason this voluntary trade of security/convenience for money shouldn't be allowed or performed.
Of course it'd be cheaper if the consumer had access to cheaper credit, but they don't, so these places have sprung up to help/serve those people. Again, I don't think there's anything inherently wrong with that. It's just expensive (for both parties).