Glad to be of help here. Let me answer the questions one by one.
- You're right about the confidence coming from investor expectations than actual enforcement experience. Startups avoid falling into patent litigation cycles as at early stages their primary goal is survival and gather funding. Health-tech requires heavy funding similar to industries like energy, or pharma. Having a patent secured innovation gives a positive signals to both potential partners and investors - that this startup has invented something new, and that their innovation is protected from being infringed. Whether a startup will actually enforce the patent in future highly depends on specific situation of their market. I have seen many startups (specifically the ones working on drug development platforms) more open to license their technology. Patents make that a little easy as it is a well known industry practice.
- It's mostly attorney driven as most founders who are working on their first or second ventures are not familiar with patent laws that well (unless they come from that background). This strategy is also only applicable in specific scenarios where it makes sense to keep the innovation hidden from competition (where you have lots of competing companies or where your work is catching lots of media attention).
- I haven't specifically seen this being discussed or got a chance to talk about it with a founder but I can share my experience here. AI/software patents are still surviving and only obvious patents are facing difficulties. You might have heard about Zoom vs Apollo dispute recently where court dismissed Apollo's motion against Zoom patents being invalid under Alice (My team is working on a story on that case separately). The patent has explained the inventiveness of the innovation being covered in a way that it is not abstract and actually showcase the improvement over prior art. If an innovation's inventiveness and improvement can be described in a non-obvious way (avoiding 'intelligent parser' and writing '0-5 point scoring system based on 5 parameters'), the patents can work.
Final thought about the last point: A patent's worth and cost is directly proportional to how important that innovation is for the industry (not for the startup patenting it). If a solution has multi-industry applications, it is not an incremental innovation but actually goes beyond SOTA, then a startup should opt for multi step protection, not just patent. Copyright the code, maintain trade secrets wherever possible, and patent the processes (if they solve the technical problems).
Feel free to share more questions or contact me on LinkedIn - https://www.linkedin.com/in/b2b-marketer/