> [Hetzner] charges a "one time setup" fee to create that VM. That puts a lot of back pressure on infrastructure decisions and removes any scalability you could otherwise enjoy in the cloud.

Hetzner Cloud, then! In the US, $0.53/hr / $333.59/mo for 48 vCPU/192GB RAM/960GB NVMe. Includes 8 TB/mo traffic, when 8 TB egress would cost $720 on EC2; more traffic is $1.20/TB when the first tier of AWS egress is $90/TB. No setup fee. Not that it's EC2 but there's clearly flexibility there.

More generally, if you want AWS, you want AWS; if you want servers you have options.