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Why are hearing aids so expensive, and reading glasses so cheap?

| Conditions | September 7, 2010

I am currently 53 years old, but I recently found an imperfection in my near-vision.  I was probably laboring for a year or so before caving in: purchasing reading glasses. I am using them right now and they have made all the difference.

In the space of a few months, I went from no reading glasses to seven pairs. I bought all seven online together as a package recently, for the grand sum of $10.00. That comes out to less than $1.50 per pair. I keep one set by my bedside, one in the kitchen, one at my office, one in the car — they’re always at hand.

Not so long ago, reading glasses would have been “fitted” by an optometrist much like prescription glasses.  They would have cost potentially hundreds of dollars apiece, but the wisdom of the market prevailed, under the implicit acknowledgment that the vast majority of cases of people needing reading glasses doesn’t require prescription-fitting. Pretty much everybody gets nearsighted in the same manner, so it’s just a matter of finding the right amount of correction in purchasing the new reading glasses. You can try one pair, and then another, until you are comfortable.

There’s the possibility that one eye’s visual correction need is different from the other’s, and for those people an optometrist consultation might be in order.  However for nearly everybody else, off the shelf reading glass purchases are adequate.  As a result, there is a great economy of scale, and eyeglass-fitting for hundreds of millions if not billions of people just a matter of choosing a correction-level and finding a nice style.  It’s really no harder than buying a pair of gloves and probably easier than buying a pair of shoes.

Along the same lines of losing our near vision, we also lose our hearing, or “go deaf” in the same manner as each other. If we can fit gloves, reading glasses, or shoes so easily, why then do hearing aids cost thousands of dollars? I recently bought a replacement Bluetooth earpiece, and it cost me $20. This Bluetooth coordinates with a variety of telephones and computer and other devices. It is tiny and extremely complicated. It has volume adjustments, battery-saving mode and probably a bunch of other features that I have not figured out yet.

Why is this purchasing paradigm so different from that of hearing aids? I know that a hearing aid has to augment sound, yet not overdo it in case a loud sound occurs where the hearing aid ‘s amplification could damage the eardrum. But really how much more complicated is a $2,000 hearing aid than a $20 Bluetooth earpiece?

I think the pricing has much more to do with lack of access on the part of the consumer to a free open market for hearing aids. Everyone is funneled through the audiology offices.

But this market is now opening up. Once this occurs, we should be able to obtain hearing aids for prices similar to the more complicated Bluetooth devices, and maybe get more features too. Wouldn’t it be nice if one could remotely control hearing aids, add GPS or item loss-prevention, or replace them for tens of dollars rather than thousands?

Remember when contact lenses cost hundreds of dollars per pair? That market has totally turned inside out. We need to open up the market for hearing aids. I’m somewhat surprised that organizations advocating for the elderly, like the AARP, have not been more proactive in this area. The AARP wants its members to have hearing aids, promotes the benefits of hearing aids, but does not appear to have done very much to open the market. They have tried to promote a tax credit for hearing aids, but this only transfers the cost, the high cost, of hearing aids to other taxpayers effectively.It would seem to me that audiologists benefit most from the current approach. But similar situations have been seen previously in other fields, like contact lenses for ophthalmologists, orthotic shoes for podiatrists, reading and other eyeglasses for optometrists, teeth whitening fittings for dentists, and anti-snoring mouthpieces for ENT’s or dentists.

We have to flip this model inside out so that the greatest benefits accrue to those with the problem: those with hearing loss. I have so many patients with hearing loss who can’t afford to go the hearing aid route. When they can purchase these items freely, try them on, and choose openly between brands, only then will prices drop.

Randall S. Bock is a primary care physician who blogs at Doctoring the Evidence.

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  • Ian

    So the optometrist and audiologist are of little value? Maybe we should buy false teeth off the shelf also?

    In fact why should anyone bother to study hard, recognise potentially dangerous situations like gas leakage with a heating engineer; carbon monoxide leaks with a mecahnic; glaucoma with the optometrist; acoustic neuroma with the the audiologist?

    In fact, why bother paying MDs high fees when one can take paracetomol off the shelf?

    • http://doctoringtheevidence.blogspot.com/ Randall S. Bock, M. D.

      I don’t believe I said that the “optometrist and audiologist are of little value”; however they do need to prove their worth in an open market, not via rent-seeking arrangements(i.e. restrictions on the availability of their ancillary products, except via their offices).

      You make, unwittingly possibly, a good suggestion about the possibility of “we should buy false teeth off the shelf also”. Perhaps not off-the-shelf per se, but I bet that somebody could provide a mold via regular mail that got shipped for the production of a reasonable facsimile of false teeth. So many of my patients don’t have teeth because of the prohibitive cost. Once these things got massmarketed price would go down by an order of magnitude.

      it is good that people “bother to study hard, recognize potentially dangerous situations like gas leakage”, but their expertise should not exclude someone else ‘s trying to take a stab at an issue before obtaining expert advice. Don’t people paint their own houses despite the fact that expert painters exist? Don’t people try to do some roofing repairs first?

      I don’t earn my medical fees through Tylenol (or paracetamol) although I do sometimes recommend its usage. When I do recommend Tylenol, though, it costs only pennies because it previously has been massmarketed.

  • http://www.consentcare.com Martin Young

    I get your point, but the intellectual property and research in aiding impaired hearing with hearing aid technology is considerable – far beyond that used for making lenses for glasses. So it’s not really a good analogy to compare the two. The challenges in fitting hearing aids are greater – they are not ‘plug and play’ like other medical devices you mention. Some patients take months to fit satisfactorily.

    I wish they were cheaper to produce while maintaining quality, but the audiologist’s services would add to the cost anyway.

    I own an audiology and hearing practice, and I know what it costs to run.

    In a perfect world…they, and glasses and artificial limbs etc. would be free, wouldn’t they?

    • Dr. J

      The strange part, in my opinion, is that most deaf people seem to be willing to pay a lot for technology. Even though the market is there it is ignored. It’s like an unexplainable abyss in free market theory!
      My Dad for instance, a notorious cheapskate, spent about $10,000 on his hearing aids and seemed to think that was fine. I would estimate that he would probably value real time voice to word technology in the same range. I would guess he would probably pay $10-15,000 for a device he could wear that would do real time voice to word translation with medium (not even high) fidelity. The tech exists, you can do this with an iphone for the cost of the phone plus a few bucks, but it is cumbersome to use and slow because the computing power is cloud based. I’m sure that sort of a product could be hugely profitable. It’s confusing that instead of an active tech market for the deaf, where people are upgrading and waiting for the newest and best tech to be released, people are in reality still using TTY phones the size of toaster ovens to communicate.

    • http://doctoringtheevidence.blogspot.com/ Randall S. Bock, M. D.

      ” the intellectual property and research in aiding impaired hearing with hearing aid technology is considerable”: that’s what patent-rights would be, but ultimately with the patent’s running out and the patient ‘s benefiting.

      The technology, while welcome and excellent possibly, is not so incredible, particularly in light of what, for instance, an iPhone can do at 1/10 the cost or less, even while it is under patent.

      “Some patients take months to fit satisfactorily.” interesting point but not dispositive to the argument.

      I would bet already they already are ” cheaper to produce while maintaining quality”

      (and this part possibly reinforces my point) “but the audiologist’s services would add to the cost anyway.”

      “I own an audiology and hearing practice, and I know what it costs to run.” I run a medical practice on my own and I understand the costs, but I am not trying to restrict access to things like knee braces or hernia trusses. I search for the things on eBay or other website for my patients and we buy them at the lowest cost. The practice will have to grow or shrink based on the market, hopefully an open market.

      “In a perfect world…they, and glasses and artificial limbs etc. would be free, wouldn’t they?” no I would consider that an imperfect world. Objects have expense associated with them cost helps filter our desires and needs. I think it’s jejune to hope for everything to be free.

  • NoVA doc

    For years there have been “game ears” resembling hearing aids for hunters, to reach parity with prey along with the all-important muzzle cutoff to prevent instant deafness. They’re much cheaper than the prescription, come in different colors and camouflage patterns, but frequencies are generally not tunable. Available at your local hunting store or L.L. Bean.

    IIRC there was a WSJ or other news article claiming that the electronics of some of these devices compare favorably to prescription hearing aids, but can’t find the source.

    • http://doctoringtheevidence.blogspot.com/ Randall S. Bock, M. D.

      great point. here’s a Wall Street Journal article, 2004, on similar topic, possibly the one you are thinking of. They make mention of hunters near the bottom.

      http://www.rasmusen.org/g406/readings-refg406/hearing.aids.wsj.htm

    • http://doctoringtheevidence.blogspot.com/ Randall S. Bock, M. D.

      I like your letter.

      I think the Wall Street journal article is this: “The Noisy Debate Over Hearing Aids: Why So Expensive?”

  • Dr. J

    The technology for the deaf is so far behind the rest of our technology it amazes me. My Dad is very deaf in spite of expensive digital hearing aids, our normal conversation goes like this:
    Dad, turn here.
    I didn’t see a deer we’re in the city.
    No, turn here.
    Return what?
    Turn around we missed our exit.
    Did anyone tell you you’re pretty confusing for someone who’s a doctor?

    That’s my Dad, deaf as a door post. I rigged up my iPhone with dragon dictate last time he was over and explained that the microphone was rigged right into the headphone cord, then I spoke to him and (with a little lag for cloud computing) he could read what I said. Well, not exactly what I said but closer than our usual conversations and he managed to interpret most of the errors correctly. You might think there would be a device that did this available for deaf people, maybe with a higher fidelity microphone, maybe with a microphone they could wear on their lapel blue toothed to a small screen that fit like a wrist watch. Nope.
    You might think he would be able to connect his own hearing aid to his computer and alter the levels of the various frequencies. Nope.
    Deaf people are stuck with making mods or with technology from years ago. It’s hard to believe since it is such a common and disabling condition but there is a huge tech gap for the deaf.

    • http://www.consentcare.com Martin Young

      There are cochlear implants if he is fit enough and has the money!!

      Very effective!!

      • Deborah Gichan

        Severe hearing impairment and profound loss are two issues. Deaf individuals may go the route of the cochlear implant but it is very difficult for the adult. Children respond well, the older the person, the more difficult. One must note that by inserting the implant all natural hearing is wiped out.

    • http://doctoringtheevidence.blogspot.com/ Randall S. Bock, M. D.

      I liked your letter.

      I have Dragon dictation on my iPhone I have it on my computers at work. When I have a completely deaf patient in, I will dictate my advice into the computer and then print it out, and have a “conversation” by that method, with the patient writing in answers under my dictated points.

      Certainly your iPhone comment points out that this technology is readily available, just needs to be popularized and dispersed.

  • SarahW

    Nobody said optometrists or even audiologists were “useless”. Just not as needed as they might hope to be, or are presented to be. To tell you the truth, though, a puff test at a mall is probably all the glaucoma screening most will ever need. And I say that as a person who has regular need of the expert services of Opthamologists – whom I know to be some of the finest diagnosticians in the practice of medicine.

    • Vox Rusticus

      A puff test routinely misses low-tension glaucomas and depending on how old and how well-maintained the non-contact tonometer device is, it may not even catch elevated intraocular pressures.

      The fact that many people don’t get testing any more extensive than the “puff test” at a shopping mall is a reflection of the prevailing choices most people make, and a reflection of the level of service and technology available where most people have fitting under their vision service insurance plans or by response to a commercial offer, not an reflection of actual need.

      Pneumatic non-contact tonometry is quick, inexpensive and does not require a highly-skilled operator to obtain a result. It does not require topical anesthetics and does not use a prism or other contact point that requires sanitizing between patients. For those reasons, it is popular with commercial eyeglass companies because it allows faster workflow using less-skilled staff. But the result is only a number, which requires an interpretation. Certainly one could flag all values that exceed the statistical upper end of normal for a referral or other analytical studies; that is usually what happens, but that is not the same thing as saying that is all the “average” person ever “needs” unless is also acceptable that you miss patients with low-tension glaucomas, or labile glaucomas or narrow angle with intermittent occlusion and damaging pressure spikes. Diagnosing glaucoma can be a complicated and lengthy process requiring months of observation by an expert with or without concurrent treatment.

      • HJ

        “The fact that many people don’t get testing any more extensive than the “puff test” at a shopping mall is a reflection of the prevailing choices most people make,…”

        So my expensive privately practicing optometrist is a cheapskate for using a puff test?

  • Jake

    Let me just address the hearing aid issue.
    For the record, these comments are from an Electrical Engineer (BSEE, MSEE, and a lot of experience).
    Here is what it takes for a hearing aid: a microphone, an amplifier, an on/off switch, perhaps a volume control, a small speaker, a battery, and a case to hold everything. That is it.
    With modern integrated circuit technology, the amplifier is probably the smallest part of the device. Microphones, a potentiometer (think of that as EE jargon for “variable resistor”), and a speaker can be made very small, not much power is required so the modern (probably zinc air) battery will be small (the on/off switch is taken care of by inserting and removing the battery), and a waterproof (or at least water resistant) case completes it. Add up the manufacturing cost and you will find that Bock’s comparison to the $20 Bluetooth is not far out of line.
    So what gets the price into the thousands of dollars?
    The sellers purportedly have to individualize the amplification of each instrument to each person. But is that required? Not really for most people. For most people, there is a normal loss (with age and environmental factors-that means exposure to loud noises) of ability to hear higher frequencies. If there were available a selection of hearing aids with amplification set for say 10 different cutoff frequencies, then the user could take a hearing test, find out which standard aid is appropriate, and buy that one. Or the user could try various ones until finding a suitable one (like going to the drug store and trying different reading glasses until finding the best one). But you cannot do that since the sellers will not let you.
    The sellers have developed very high technology devices (think high development costs that need to be recouped, but then very low manufacturing costs-sound familiar? Isn’t it a lot like drugs?) that can program the aid to the “exact” hearing loss of the user. Only the seller has the equipment to do that. And the seller (the audiologist) charges a lot to do that-as Young says, operating a facility to do that is expensive (physicians undoubtedly already knew that). Plus the audiologist requires a lot of expensive training-current trend is to require an Au. D. (Doctor of Audiology) or a Ph. D. in audiology. Let’s be realistic-the procedure for programming the hearing aid is academically at the Associate Degree level. That is not a mistake. My ophthalmologist (a medical school faculty member) has refractions done by someone who learned to do them on an OJT basis, and many use Optometrists to do them. A technician with an associate degree would be the proper academic level for programming a hearing aid.
    But you don’t need to program them for most people. Just pick a standard model that most closely meets the user requirements.
    So we have very expensive equipment (on which the manufacturers need to recoup their development expenses), sold by very expensive people using very expensive facilities.
    I am not suggesting that there is a formal cartel, but informally the system seems to operate as a cartel.
    But you can buy hearing aids on eBay, and there are some audiologists who will program them for a reasonable fee. I suggest that Block’s father try that approach.

    • J.T. Wenting

      TBH, hearing aids are now often molded to fit the specific shape of the customer’s ear.
      Many have circuitry to filter out environmental sound, preventing them from amplifying background noise so the human voice is more easily distinguished.
      Many patients have hearing loss in specific frequency bands only, so don’t need (and in fact it would be counterproductive) a full (or broad) spectrum amplifier.

      I think in that hearing aids are quite different from reading glasses where indeed the majority of customers don’t require such customisation.

      Whether the cost of thousands to tens of thousands of dollars for a hearing aid reflects the actual cost of producing it using that scenario I can’t tell, I don’t have access to financial figures for the industry.
      But the fact that insurance companies are willing to pay that cost (or at least a large part of it) tells me it’s not that excessive. If it were they’d enter into exclusive contracts with specific suppliers and refer all their policy holders to them, a situation where the insurance company gets to pay less and the audiologist has a guaranteed clientele (always an incentive to reduce prices, having a captive audience).

      I don’t need a hearing aid (thankfully), hopefully never will (I see the problems my dad has with his hearing regularly, don’t want that for myself). But my reading glasses cost me some $500, and aren’t at all remarkable for made to order glasses.
      My regular glasses (can’t use bifocals) cost twice that.

  • Max

    They’re overpriced. Bottom line. I wonder what the markup is? 500%? 1000?%

  • http://www.occampm.com/blog Michelle W

    A minor correction due to personal experience: “Pretty much everybody gets nearsighted in the same manner,” I believe the word here is farsighted if you’re discussing reading glasses (nearsighted would mean glasses for distance rather than close-up work like reading).

    As for the hearing issue, I know my grandmother has been through several devices that required lots of custom work (the filtering and custom fit referenced earlier). I don’t have the medical background to make a firm statement, but from limited observation on my part it seems that, on average, significant hearing loss occurs later in life than vision loss which is associated with dollar store glasses and thus seems more severe and to deteriorate quicker. Wouldn’t that effect the amount of custom fitting work required?

  • anonymous

    how come my regular glasses are close to $500? i’m nearly blind without them, so that includes thin lenses and coatings and other extras.

    • Christine

      If my glasses were that expensive I would get LASIK in a heart beat. Actually, my glasses were free every other year with insurance, and I still got LASIK.

  • http://www.consentcare.com Martin Young

    I can buy a cheap CD in my music store for as little as $5 in our money equivalent.

    So why is the Windows 7 software, also on a CD that looks very similar, so much more expensive??

    You and I both know why. Same applies to hearing aids.

  • Vox Rusticus

    Reading glasses are cheap because they are mass-produced in automated factories in low-wage countries. Like ordinary shoes, they are made to one power that is the same in each eye. Like inexpensive factory-made shoes, they are made to common sizes; no special fitting is provided. If one eye is more presbyopic than the other (it happens) you have to make do with the best compromise that gets you what you need, Likewise, if you have astigmatism or dysmetropia, you will get no correction for that. No one is going to tailor a pair of readers that you buy at a discount store to your special needs.

    Prescription glasses are more bespoke. Like handmade shoes or a tailor-made suit, they require more time of a skilled examiner and a skilled technician, so they cost more. Hearing aids as most people buy them are fitted this way, like prescription eyeglasses or a custom suit, fitted to the wearer and adjusted to the specific needs of the patient and the ear.

    You can get off the rack hearing aids. They are much cheaper and don’t come with any professional fitting. Are they as good? Of course not.

  • Christine

    You can buy simple noise amplifiers cheaply that are like earbuds that go in the ear. They are connected to a little microphone device that’s worn around the neck or something.

    Basically all you’re getting when you’re getting cheap reading glasses is a magnifying glass.

    Both will get the job done in a pinch. Neither is nearly as good as their expensive counter-parts.

  • Clint

    I will take issue with the oversimplification of the fitting of a hearing aid device. As someone who has worn them all their life, (12 pairs and counting) depends on them to be off the dole, the fitting of the aid is a delicate process that requires tuning over the initial fit-in of the hearing aid. With each set one has to re-learn the correct social cues for one’s own voice and the surrounding environment. This takes time and adjustment to regress the variables of the settings. Just like one would not put on and wear “Aunt Martha’s” reading glasses without feeling nauseated, the “one-size fits all” hearing aid would give you headaches and sensory overload that many would not imagine. To the end of the audiologist (or HA dispenser) having all the answers, I’ve trained more than my share in the realities of a fit-in and have a standing challenge for them to wear a set for a month and understand the vagaries of the process.

    Off of that soapbox and on to the other “main” point of the article: I have paid in the $6,000 to $7,000 range of the last several pairs and consider the $100/month investment as an ante to my participation in professional life. (Cash mind you as the insurance benefits were beyond the small business plan I have participated with) Only recently did I find a mainstream alternative to that ride with an unnamed wholesale franchise (you do the research here).

    I will echo the sentiment that the technology of the HA is significantly missing the stride with most of the computer programs available on these digital signal processors are inept in isolating the particular voice one is trying to hear at the time. Much more useful is the directional microphone and background cancellation combination that allows me to shut off the dorsal acoustical hemisphere in the local pub. The analogy of reading glasses vs hearing aids should be limited to a discussion of price points as the complexity of what the devices are doing would ask the glasses to be able to enhance only the red spectrum up to the point while filtering out stray sunlight and magnifying only what you are looking at during that moment.

    I hope all who read never need them, but if you do, be glad they can allow you to reintegrate into society.

  • MillCreek

    As someone who has worked in healthcare all my life, I have never had any insurance benefits for hearing aids. I have had to pay for them out of pocket. My last set cost $ 7000. There is usually a 100% markup on hearing aids.

    • http://doctoringtheevidence.blogspot.com/ Randall S. Bock, M. D.

      possibly you are right about the markup, I don’t know. My point is that the overall price, even wholesale, would go down once the market was opened up.

      Audiology-referrals would occur for those cases that can’t be accommodated in the general retail arena.

      think about what has happened with contact lenses’ prices over the years,

  • Jake

    It is the placebo effect.

    I should have realized this at first.

    When Wenting pays $500 for reading glasses and Clint pays $7K for hearing aids, they firmly believe that they are getting something better, even though, in most cases, they are just getting brand names or other assurances (eg. from an Audiologist with an Au. D. degree) that theirs is better, was fitted and programmed better, etc.

    Physicians should be the first to realize that there are many people out there who, as a result of the placebo effect, firmly believe that their brand name, very expensive drug is a lot better than the generic equivalent. As these discussions show, similar things happen with hearing aids and reading glasses.

    • Clint

      Jake – Your conclusion is unfounded in the case of hearing aids. The placebo effect is nowhere to be found.

      It is a matter of the degree of performance and adaptability required of the digital signal processor to:
      1. meet the loss in amplification in the ranges required by the user (your premise)
      2. their tolerance to the effects of processing delay,
      3. their tolerance to compression of the 100db into XXdb of usable range
      4. their tolerance to having these devices plugging up their ears (physiologically and aesthetically)

      Given two users with the same losses, they will have differing tolerances to each of the factors above (save the first). Their ability to adapt (physically, mentally, or expectations) will determine their success to wearing them at all. If you suddenly had the same loss as I do, you would require a different level and response of compression than I require. That level would change over time and you would need adjustments to your profile. Nothing you could stick in your ear or carry in a laptop would allow you to hear exactly as you had before.

      Your vision of a device to meet those 10 users types already exists, though not at the price point you envision. Does it need to be $10K, $7K or $3K? Probably not, but unless we have your expertise with fabrication, we have to buy it from someone. What would be a fair price for your device after you do the R&D, marketing and provide a service to select and sell? How many would you sell in a year? What markup would be fair? Your desired risk and economics would probably dictate a different answer than a purchaser’s. Hence our quandary.

      I agree that the markup is confusing and frustrating. I can say that my insurance contracting discounts the cash price from $7K to $3K for a pair. The $3K rings true as Costco offers an equivalent product for the same price point with similar service. This leads me to believe that this is much more the natural price point than the list price. (This is the first time I’ve had coverage myself.)

      I truly wish I could buy an off the shelf device for $99.95, but experience shows me that I cannot obtain the required performance necessary at 10x that price.

      You can write me off as as a fan-boy of the system. I am not. I have lived this reality with hearing aids for nearly 40 years – from analog through digital programmable. I remember hearing about audio inversion processing in 1984 and waiting for it to come to my devices. I have more than once delayed purchasing because I could not afford a set at the time.

      My goal here is to give the non impaired a realistic discussion of the technology and pricing from my viewpoint as it is easy to oversimplify this issue without actual experience with a hearing loss. There are nuances that experienced dispensers and users cannot answer without trial and error of settings and time for your hearing to adjust. Each piece of hardware and their programming interacts differently with the mix of requirements.

      Again, I hope you never need them.

      Kind regards.

      • Jake

        Clint

        You said: “The placebo effect is nowhere to be found.” Perhaps that is because no one is looking for it. There have been many medical treatments, long accepted as efficacious, but when examined for the placebo effect were found to have virtually no benefits except as a placebo. This could very well be one of them.

        Certainly your listing of 4 requirements for digital signal processors provides no evidence against (or for) a placebo effect (your 4th one is of particular irrelevance since modern hearing aids can work quite well without “plugging up” the user’s ears).

        I am certain that a study could be formulated to determine the placebo effect (and other factors) affecting the procedures you describe for hearing aid fittings and sales. But, it appears that it is not likely that anyone has a financial incentive to do so (the manufacturers and audiologists certainly do not want to do so).

        Also, your figure of $99.95 for an off the shelf unit is of particular interest. Where does that come from? Certainly not from me.

        I would think that someone who has had to live with the current system for 40 years would be among the first to advocate action to make it better, and would not dismiss suggestions for improvement in such a cavalier manner.

  • Generics are close, not identical

    Jake, with respect, there are many narrow therapeutic range drugs where patients have trouble switching constantly from brand to generic to different generic – and for some conditions variation at ranges accepted by the FDA can lead to catastrophic differences in patients.

    Perhaps even more concerning is that the content of generics is practically on the honor system, and even your pharmacist is unlikely to able to tell you where the ingredients in your pill came from – excipients in particular.

  • Jake

    It may be true that “there are many narrow therapeutic range drugs where patients have trouble switching constantly from brand to generic to different generic – and for some conditions variation at ranges accepted by the FDA can lead to catastrophic differences in patients” as you say. I suspect that it is also true that many patients find generics to be quite satisfactory (at least my physician thinks so and assures me that there are numerous, peer reviewed publications that indicate this). This, of course, does not mean that they always are.

    But the issue in this discussion is about reading glasses and hearing aids, so your discussion is not relevant. It would certainly be to the benefit of someone who has a hearing loss and is now suffering with it because of the high cost of hearing aids, if they could be obtained for less cost. Likewise, that $500 figure for reading glasses may be appropriate for some medical conditions, but people should understand that in most cases, the situation can be handled for much less.

  • Deborah Gichan

    As a parent of a hearing impaired child I have thought long and hard about this cost, and the utter need to have my child hear so that she could learn to speak and participate in school, in life, often to a tune of $5000 for state of the ar…t hearing aids. Over the past 14 years I have watched this technology advance and am thankful for the consistent improvements made. Advancements that allow her to speak on the phone, and listen, to walk into an auditorium without getting a headache. Technology has advanced from mere amplification to the subtle needs of the environment and sound within.

    And as a parent who can not always write a $5000 check for each advancement, not to mention ear molds that must get replaced each time there is a growth spurt, certainly I hope that the cost will go down.

    As far as elderly concerns, the recycling of older hearing aids for that community is available. Personally, my daughters last technology albeit purple are happily used by my mom.

    • http://doctoringtheevidence.blogspot.com/ Randall S. Bock, M. D.

      thank you for finding your way to this site and posting. I think it’s important for consumers to make the effort on this issue, then great headway will be made. Probably consumer-push will prove to be more effective than internecine medical debate, with competing factions’ rent-seeking arrangements in play.

      In 2004 the Wall Street Journal covered this issue:
      “The Noisy Debate Over Hearing Aids: Why So Expensive?”

      have we made any headway since then?

  • Clint

    Jake

    The assertion that a placebo effect is occurring implies that one cannot tell the difference. I’m saying you can. I though I had made that point earlier with the detail above.

    I am in agreement with you that the devices could be cheaper. I have found cheaper alternatives to traditional dispensers that maintain the required performance. They are available to all cash payers and to some insurance payers.

    My $99.95 is satire as I erased the “Ronco” as I edited. The point here is that by the time you make an miniature IC assembly with the capabilities to process sound in almost real time, my guess is that it will cost the end user somewhere in the $2K range for a pair after factoring everything. Add to this the time to select the standard device, quarterly service, and repairs as a bundle and we’re somewhere around the $3K mark. Ironically, the latest “Lyric” devices are disposable analog devices that cost $18K a pair per 5yrs. Now that is a crying shame bordering on criminal.

    I take offense to your characterization of cavalier. Try passionate and more frustrated than you might ever imagine. What I really take issue with is your simplification and dismissal of the real issues of hearing aid daily life.

    Your comments reflect a lack of experience with the details of wearing hearing aids. Simply that. Your comment about occlusion being a non issue (i.e. “plugging up”) illustrates this. There are limits to the db power you can put in a vented space before it causes feedback. Too much venting = feedback, too little = occlusion; it is a fine line and a painfully loud and uncomfortable one.

    The take-away is that hearing aids have a complicated job to do and fitting devices is complicated even to the experienced end user. One pays for a level of performance (think Yugo vs Porsche). You can tell the difference of fitting and it makes a difference. Could you build and buy an off the rack solution? Yes, but I would compare it before I bought it. As most people are on the first or second set and are clueless to what they really need; they have no experience to discern the difference.

    I would be willing to explore the potential of the alternative, but only after understanding the real specs and details that make a daily difference. That would be a discussion worthy of all our time.

  • http://fertilityfile.com IVF-MD

    Great insight, Dr. Bock.

    The comments are interesting too. We don’t even have to agree on whether over-the-counter hearing aids and over-the-counter corrective lenses would be as good as professionally fitted ones or not. The big debate is whether people should be free to have options or not. Let’s allow the market to decide.

    So why not allow the freedom to sell glasses for myopia over-the-counter the way that hyperopia-correcting reading glasses are currently sold for $1.50? That way, nobody has to make this academic argument of whether they would be as good as “professionally-fitted” lens or not. Let people buy them. If they don’t get the sharp vision they want, then they will go to the optometrist. If they ARE satisfied with them, then they have just saved $300+ on their healthcare! Everyone wins!

    As for the two eyes having different prescriptions, what genius of engineering would it take for a manufacturer in a free market to design interchangeable lenses? The bottom line is taking away the right of nearsighted patients to buy lenses over-the-counter infringes on their right to gaining improved vision at lower costs.

    The same applies to the hearing aids. If somebody wants to throw away $50 (or whatever the market can make them for) on cheap OTC hearing assistance devices, let them. If it works great, then they will have saved $2000+ and be very happy. They’ll tell their hearing-impaired friends who will then buy more of the $50 cheapo devices and the company will prosper and have R&D money to further improve their product. If they are NOT satisfied, then they will compliantly go get fitted by a professional audiologist, tell all their friends about how bad the OTC ones were and that company will suffer.

    As a physician myself (reproductive endocrinologist), I want people to come see me because they realize that the treatment options I can provide them beats all the non-MD options out there, not because I have some artificial coercive monopoly on the treatment of infertility. Some of my colleagues are up in arms about acupuncturists lobbying for the privilege or ordering hormonal lab tests. They rant that the ability to order lab tests should be the monopolistic privilege of a doctor. I disagree. If the lab results can assist an acupuncturist in helping his patients conceive, more power to him. Meanwhile, the burden is on me and my colleagues to make sure that the surgery, IUIs and IVF cycles we provide are cost-effective in helping patients have babies. If not, we had better try harder to improve or else the herbalists, chiropractors and Chinese-Medicine experts will get a huge share of our patients, and rightfully so.

  • http://centva.com smbane

    As a former Navy Flight Surgeon who refracted lenses for my pilots and Marines and now an ENT doc who employs an audiologist the gap between hearing aids and glasses is huge. Hearing aids are so much better now but also more complicated. If you want it to work you need a professional.

  • Neila

    Hearing ais costs are way out of control; the person fitiing the aid is making a ton of money!! An aid cost the dealer around $250.00, some are more of course, but the consumer pays $2000.00 or more!! This is truely robbing the elderly!!! It does pay to sop around, see about three dealers and compare prices and types of aids!!!

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