I know it's used to always allow an instruction to run but why is it necessary? For example, why can't I just have output Y0 connected directly to the left power rail?
You can when it is the first output after a "block" instruction, e.g. the first rung, or the first rung after a FOR, or the first rung after a SG.
The PLC does not know what a "rung" is. It uses a push-down-stack for the Boolean logic. Hence, if there is no input contacts, the OUT coil looks at the "top of stack". Hence, if it wasn't one of the previous mentioned "beginning of block" instructions, it is based on the ToS of the previous rung (or possible a rung before THAT).