Wouldn’t having a spatial index give you most of the performance gains talked about here without needing H3?
Yes. And it should be faster. They may forget to create spatial index.
They may well be using some data storage where spatial indexing is not possible or standard. Geoparquet is a common one now - a great format in many ways but spatial indexing isnt there.
Postgres may be out of fashion but still an old fashioned postgis server is the simplest solution sometimes.