The consequences are so much more significant than people seem to realize.
Because of NAT, hierarchy (centralized servers) is the foundational design pattern of the internet, and anyone who wants any semblance of anarchy (decentralized networks) must use a workaround that is itself hierarchical and costly. We are all interconnected, but only a wealthy few can truly speak fist.
while i agree with your sentiment, i personally think that the foundational design pattern of the internet as a network is highly decentralized. once you get public IP space and the infrastructure required to talk BGP, making decentralized designs is actually quite easy.
The issue that ipv4 exhausting and "solutions" around it like NAT are making it very hard for actual users (bussiness, people etc) to get access to public IP space without strings attached.
IPv6 solves a lot of this, especially because IP space is so massive LIR's don't need to be so spare with giving out address space.
The far larger issue we have is that applications are ingrained in a client server mindset, in which big incumbents want to have this architecture because it forces control from the server towards to client. And control usually also means having the data itself, which is where the real value lies.