[mattbillenstein]

If you have a database, you still have work to do - optimizing, understanding indexes, etc. Managed services don't solve these problems for you magically and once you do them, just running the db itself isn't such a big deal and it's probably easier to tune for what you want to do.

[sanderjd]

Absolutely yes. But you have to do this either way. So it's just purely additive work to run the infrastructure as well.

I think if it were true that the tuning is easier if you run the infrastructure yourself, then this would be a good point. But in my experience, this isn't the case for a couple reasons. First of all, the majority of tuning wins (indexes, etc.) are not on the infrastructure side, so it's not a big win to run it yourself. But then also, the professionals working at a managed DB vendor are better at doing the kind of tuning that is useful on the infra side.

[mattbillenstein]

Maybe, but you're paying through the nose continually for something you could learn to do once - or someone on your team could easily learn with a little time and practice. Like, if this is a tradeoff you want to make, it's fine, but at some point learning that 10% more can halve your hosting costs so it's well worth it.