On Hetzner you will be on the hook for managing the database though, and DBA is most certainly a full-time job if you have a serious use-case for it.
1 GB of RAM for Postgres is really only useful for tinkering IMHO. Even for development, you’ll quickly need more memory, so HA doesn’t provide much value here. If you go with something even remotely reasonable (4 GB RAM, 200 GB SSD, 1/2 vCPU — and that’s still on the low end), the cost jumps to about $290/month. For that price, you could easily hire someone to set up HA Postgres for you on Hetzner or OVH and once configured, HA Postgres typically requires minimal ongoing maintenance.
Also, this is a shared server, not a truly dedicated one like you’d get with bare-metal providers. So, calling it "Metal" might be misleading marketing trick, but if you want someone to always blame and don’t mind overpaying for that comfort, then the managed option might be the right thing.
Considering they are charging an unfathomable $4529/mo for 256 GB databases, extrapolating that to a serious use case you can indeed just hire someone full-time with how much you'd save. And then you'll actually have someone who understands how databases work instead of treating it like an expensive black box.
edit: my bad that's the price for 256GB RAM.