Not all musicians pay for copyrighted material
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but still make money on it and sometimes get caught out.
You can correct me if I am wrong, Honey Select can be downloaded for free, Ren'Py is available for free. So someone if they want to can create a game for free and share it on patreon. The only thing it has cost them is time.
Don't get me wrong I am not saying that Miagamehouse is doing anything morally right or that all devs do not put any effort in to their games. I am just pointing out how some devs can provide games for patreon without any original content except for Storyline and many also have not so original stories such as shagging mom/sister/sisters/daughter/aunt etc......