However the overwhelming number of cases where a website is unusable with a screen reader are due to lack of proper semantic tagging, like alt text and so on. The last thing a screenreader user wants to hear on a site is "button," "button," "button..." There's certainly room for tooling to help though. I definitely think it sucks that many accessibility linters are nonfree and thus will never be used by site devs who aren't worth suing.

It's worth remembering that accessibility helps everyone, not just the disabled. In fact one of the more popular arguments against accessibility is that it allows non-disabled persons to do more than intended.

So while there's a good argument to be made for being charitable to those with a frankly really lousy condition, if you just want to be self-centered you still benefit from properly tagged data.