I recently read a fascinating article in the Independent about a very hot-button topic, de-funding the police. After the tragic death of Daniel Prude, the Rochester, NY City Council overwhelmingly voted to divert a percentage (~4%) of the police budget to create (among other things) what are known as ‘Person In Crisis’ or PIC teams. The PIC teams are staffed by mental health professionals 24/7, and they are dispatched (along with police officers) on any 911 call potentially involving a mental health crisis. Police, like all emergency services, play a vital role in the function & safety of our communities. But officers are too often tasked with responding to situations that they are not trained or ill equipped for. Often when problems are misdiagnosed and/or mis-treated, bad outcomes can become inevitable and predictable. Thankfully, according to the article, although there’s been a learning curve and “growing pains” for and between the PIC teams & their police colleagues, the reaction from the public “has been all positive”. In a time where it seems like the whole world is burning down around us, quite literally and figuratively, it’s heartening to hear about folks working together to correctly diagnose and address the very real problems we face. We’re always stronger when we work together.
So what does this have to do with Audiology or hearing healthcare? Numerous stories about President Biden’s recent “Executive Order on Promoting Competition in the American Economy” caught my eye. Although it covers everything from ‘net neutrality’ to prescription drugs to airline baggage fees, from some of the headlines (“Biden Listened on Hearing Aids”; “Hearing aids cost an average of $5000. Biden’s plan to make them affordable doesn’t go far enough”) you’d never guess that the totality of the Order dedicated to hearing aids is less than 50 words-stating the FDA has 120 days to finish the job of publishing guidelines for Over-The-Counter/OTC hearing aids. When something’s mis-diagnosed and/or mis-treated…
The Executive Order’s ‘remedy’ (OTC) addresses only one piece of the puzzle, therefore it doesn’t affect any of the other fundamental issues, all while effectively scapegoating the major hearing aid manufacturers and hearing healthcare professionals. Please understand, I agree that good hearing healthcare is out of reach for many people. Though the same could be said for good healthcare in general. But hearing aids don’t cost what they do simply (or even mostly) because of a lack of competition in the industry.
On the front end, manufacturing hearing aids is expensive for several reasons, including (but certainly not limited to) existing laws governing their purchase/return, production, R&D, marketing,etc. On the back end, professionally dispensed hearing aids cost what they do because consumers are fundamentally paying for hearing healthcare.
Hearing aids are the tool we use to treat hearing loss, but they are not ‘hearing healthcare’. Consumers are paying for professional medical services–programming/verifying/fine-tuning that tool, instruction, counseling and years of ongoing healthcare. That’s why ‘hearing aids’ cost as much as they do. Because that’s what good hearing healthcare looks like! Unfortunately, the focus on the devices does nothing to address the cost of professional hearing healthcare, because it puts no value on that care. It reduces hearing healthcare to a device that’s fit/used with no medical expertise at all. For some, that will address their immediate need. But don’t mistake that for healthcare, let alone good healthcare.
Insurance, or lack thereof, is also a major factor in the cost. Medicare only covers a hearing test once a year, but no treatment. Most private insurance typically follows Medicare guidelines and therefore also doesn’t cover treatment. I can’t think of another significant medical issue where both diagnosis and treatment aren’t in some way covered by (public or private) health insurance. Not when it comes to hearing loss. So unsurprisingly, the vast majority of people have to pay out-of-pocket. Were Medicare and the insurance companies to cover the treatment for hearing loss (i.e. hearing aids), device costs would plummet from the sheer numbers manufacturers would sell. But don’t hold your breath. Insurance companies are in business to make money and hearing aids are a losing bet for them. Why? Insurance companies work by taking the cost of an uncommon, but insurable risk, and spreading it over a large group of people. Hearing loss isn’t uncommon and therefore the likelihood of an insured using their benefit doesn’t work in the company’s favor. It’s not a money maker for them.
It’s critical to diagnose the issue of hearing aid cost correctly so that people do get the treatment they need and can afford. To my mind, the biggest factor is that hearing healthcare in America is regarded as a commodity (i.e. “hearing aids”).
Again, don’t get me wrong. As I’ve written before regarding OTC, I think it is (overall) a good policy decision to give folks with early hearing loss a less expensive treatment option, albeit a self-care one.
But without a good concomitant public educational component regarding the benefits of early & consistent treatment, the way this is being ‘rolled out’, will just likely lead to more confusion for many (most?) as to what constitutes hearing healthcare-let alone GOOD hearing healthcare. To me, sadly predictable and inevitable.
Stay tuned for Part II – ”Are hearing aids so expensive?!”
Please continue to love your community by getting vaccinated and continuing to mask/distance when & where appropriate. And please always support your local businesses.
