Why Can't Industry Design an Affordable Hearing Aid?

Hugh Pickens writes "Tricia Romano writes in the NY Times that over the last 10 years, purchasing a hearing aid had become even more difficult and confusing than buying a new car — and almost as expensive. 'I visited Hearx, the national chain where I had bought my previous aids. There, a fastidious young man spread out a brochure for my preferred brand, Siemens, and showed me three models. The cheapest, a Siemens Motion 300, started at $1,600. The top-of-the-line model was more than $2,000 — for one ear. I gasped.' A hearing aid is basically just a microphone and amplifier in your ear so it isn't clear why it costs thousands of dollars while other electronic equipment like cellphones, computers and televisions have gotten cheaper. Russ Apfel, an engineer who designed a technology now found in all hearing aids, says there is no good reason for the high prices. 'The hearing aid industry uses every new thing, like digital or a new algorithm, to raise prices,' says Apfel. 'The semiconductor industry traditionally reduces the cost of products by 10 to 15 percent a year,' he said, but 'hearing aids go up 8 percent a year annually' and have for the last 20 years."

Comments

three words, one hyphen:

[Black Parrot]

for-profit healthcare

Re:three words, one hyphen:

[Anonymous Coward]

very true. I wonder what the companies profit margins are.

Re:three words, one hyphen:

[malraid]

It's not only this. Insurance also drives prices up for regular consumer. If everyone paid out of pocket, I can assure you it would be way cheaper.

Re:three words, one hyphen:

[pixelpusher220]

and lots of people who need them wouldn't get them...

Re:three words, one hyphen:

[K. S. Kyosuke]

It's not only this. Insurance also drives prices up for regular consumer. If everyone paid out of pocket, I can assure you it would be way cheaper.

This stuff almost feels like defense contracts, actually. Easier to throw money around when it's someone else's money.

Re:three words, one hyphen:

[jhoegl]

Incorrect.
Insurance companies barter/bargain for the lowest prices.
They say, we have this many people over this age, and they are likely to buy hearing aids. Give us a deal and we will pay it minus the copay
If it were individual, it would be like a car salesman... attempting to charge the highest price, ask you to take out a loan and pay it.
Some people will barter, but we all know the for-profit from OP was correct.

Re:three words, one hyphen:

[Anonymous Coward]

for-profit healthcare

One only need observe the non-profit cell phone market to see the wisdom of your sentiment.

Re:three words, one hyphen:

[Anonymous Coward]

Can you cite the costs for the same device in non-for-profit countries? I dare ya.

Re:three words, one hyphen:

[Hadlock]

If teenagers can afford a smart phone (+ monthly data plan), I suspect a usable hearing aid could be manufactured for the same price, even if it doesn't have 3G internet and multitouch display.

Re:three words, one hyphen:

[Volante3192]

http://www.nhs.uk/chq/Pages/894.aspx?CategoryID=68&SubCategoryID=157

NHS hearing aids and new batteries are free. If you lose your hearing aid or damage it, you may be asked to pay towards the cost of repairing or replacing it.

Re:three words, one hyphen:

[Mike Buddha]

Oh, I thought you were going to say mal-practice insurance.

Re:three words, one hyphen:

[guruevi]

Payed for by the government but still lists at 3000 (Belgium) - my great-aunt payed EUR 500 copay and she lives on welfare

Re:three words, one hyphen:

[DigiShaman]

I tried paying for a new car with one phat check paid in full. The sale guy said my cost would go up by a few grand unless I financed through their loan department. Toyota Financial. Basically, they want to bank on the interest rate.

Re:three words, one hyphen:

[malraid]

Maybe lots of people wouldn't be able to get them. Or maybe prices would drop enough that you be looking at most people being able to get them. Given the nature of most electronic products, I wouldn't be surprised if competition wouldn't drive prices down so much that most people who have insurance right now, would be able to afford them (basic models close to what people pay right now for the insurance copay). In that scenario (which might be too idealistic), some people wouldn't be able to get them anyhow, same as now people without insurance don't have much option.

Re:three words, one hyphen:

[jmichaelg]

I'll see your three words and go in two; no hyphen: Regulatory Capture.

Healthcare is expensive because the government passes scores of rules that benefit the incumbents and keep out innovation. They pass those regulations because someone ends getting richer as a result.

  Ear Trumpet's developers received a cease and desist from the FDA after they published an iPhone App that tested your hearing and then loaded an equalizer to adapt playback response according to the test results. That's all they were selling - a test and an equalizer with presets. But you can't buy it anymore because the FDA objected.

Another case in point. One of my students' father was trained as an M.D. in China. The family emigrated to the U.S. and the father had to go through medical school all over just to prove he knew what he was doing. The only thing that improved in med school was his English. Were he, and hundreds of thousands other fully capable practitioners, able to come here and just hang out their shingle, you'd see health care costs plummet. But no. The medical profession protects its own from competition by convincing everyone they know best by limiting the number of doctors and med students.

Healthcare would be a hell of a lot cheaper if the government stayed the hell out of it.

Re:three words, one hyphen:

[ThatsMyNick]

This is more likely to have been caused by price fixing. I dont imagine there would more than 2-3 hearing manufactures. It seems they have decided to maintain the status quo, than compete.

Re:three words, one hyphen:

[Anonymous Coward]

A medical doctor I later tried unsuccessfully to fuck told me that one factor in skyrocketing healthcare costs, in America at least, was the increasingly litigious environment driving up malpractice insurance and prompting medical centers to order increasing numbers of unnecessary tests so the patient won't come back later and sue the living piss out of the hospital because they had missed something unrelated to what the patient came in for.

It's funny how the American pigs point the finger at "greedy insurance companies" even as they considered suing that mom-and-pop store for millions of dollars because they almost slipped on a floor.

-- Ethanol-fueled

Re:three words, one hyphen:

[Anonymous Coward]

Sorry, but you've been misinformed. If you have any medical procedure done, you can call them and ask for a discount because you are uninsured and paying out-of-pocket. Although they are not obligated to do so, they usually will, and you will often only have to pay 25%ish of the original costs.
If you think my surgeon would have made me come up with $16k (the amount they billed my insurance for) cash for my 1-hour procedure if I had no insurance, then you have a strong misunderstanding of how the healthcare industry works. I'd like to think I know at least a little bit about it. After all, I'm employed at a hospital.

Re:three words, one hyphen:

[Anonymous Coward]

Actually, it's because of government sponsored healthcare. The type that is wholly a for-profit enterprise, such as Lasik, consistently gets cheaper. When the government gets involved, the prices go up.

Re:three words, one hyphen:

[Anonymous Coward]

No, it isn't "for profit" per se that causes the high prices. It begins with the way consumers perceive their insurance plan. They see the insurance payment as a sunk cost, and don't really want to spend any less than the maximum that the company will pay. In addition, most people are willing to pay extra out of their own pocket to get better equipment, so the hearing aid companies set their prices to encourage that. The medical device designation is a significant barrier to entry, and so minimizes competition. These factors combine to set the price.

Re:three words, one hyphen:

[PopeRatzo]

Given the nature of most electronic products, I wouldn't be surprised if competition wouldn't drive prices down so much that

The iPad mini is evidence that competition doesn't reliably drive prices down.

When you have products that are highly desirable (and if you're hearing-impaired, a hearing aid is highly desirable) then prices will stay as high as people are willing to pay.

There is no "law of supply and demand". It's a fiction.

Re:three words, one hyphen:

[Anonymous Coward]

It's not only this. Insurance also drives prices up for regular consumer. If everyone paid out of pocket, I can assure you it would be way cheaper.

You have assured everyone of this and you have been modded +5 Insightful.

Can anyone show me where this is shown to be true with a very high degree of certainty and credibility?

Because to me, this just shows that even a majority of Slashdotters have fallen on populist craziness these days. When people turn so insane their minds stop working and they can just chase a dream.

Re:three words, one hyphen:

[Anonymous Coward]

one word: insurance

Re:three words, one hyphen:

[MBCook]

How many people who need them now don't get them because they can't afford $2k+ when they should be paying maybe $250?

I know that's the case for at least two of my relatives.

Re:three words, one hyphen:

[narcc]

I haven't checked, but I'll bet they'd even make Apple blush...

Re:three words, one hyphen:

[Anonymous Coward]

For-Vanity-Sex

People will pay for 'perceptions' dearly. That is why Dentists, Plastic cosmetic surgery, and living in hot inner city condos has a premium and has gone UP.

But a hearing aid is a product, and electronics, a bit of transformed plastic, and should have gone way down. Same for 'Hair-Fusion' shops that want $3000 for a wig and some glue (but if you go in, they will never use the word 'wig' or 'hairpiece' - not never).

But the hearing aid people have leveraged the same BS as all those glass/spectacle/ eye wear shops. And they have kept the price off Ebay/Amazon as well as side by side reviews.(oh everyone has to be customized- yah yah).

Hearing slightly different. Some will pay to keep or get a job (#1 priority in this economy). Come to an interview with a disability...
no income - scare tactics. baby boomers have stacks of cash and demand 'yes's'.

Hearing shops, like Hairpiece, hair removal and laser dermo shops have invested HARD in delivering great customer service, with a good smear of lies and B/S to get that wallet to open up.

The price of hearing aids is dropping, now that some are out there with Bluetooth like DIY no tools filter/tuning on your own PC. But they COULD add a few more directional microphones and prevent 'commoditization' for many years yet.

I'll spoil someones patent idea, that a garden variety mobile phone with a 1.5Ghz processor and probably just existing hardware, and software making use of the vector graphics components should be able to blow away the best hearing aids now. Hearing aid app.. $1.99 done!

Re:three words, one hyphen:

[Anonymous Coward]

Healthcare would be a hell of a lot cheaper if patent law were reformed. FTFY

Re:three words, one hyphen:

[__aarzwb9394]

Healthcare would be a hell of a lot cheaper if the government stayed the hell out of it.

If gubmint stayed out of healthcare costs would go down, and we'd only have a few thousand extra deaths a month from con artists to balance against all that lovely freedom.
You would like the USofA (fuck yeah!) to no-questions-recognise medical qualifications from the commies?
Interesting freeper sentiment...

Re:three words, one hyphen:

[Anonymous Coward]

Because only teenagers who can afford smart phones need hearing aids.

Re:three words, one hyphen:

[Fned]

Healthcare would be a hell of a lot cheaper if the government stayed the hell out of it.

You get what you pay for...

Re:three words, one hyphen:

[Nethead]

Were he, and hundreds of thousands other fully capable practitioners, able to come here and just hang out their shingle,Were he, and hundreds of thousands other fully capable practitioners, able to come here and just hang out their shingle,..

Add to that all the returning US veterans that have been performing their skills under fire but can't get a job back home because they don't have the correct certification.

Re:three words, one hyphen:

[Anonymous Coward]

If government stayed out of healthcare, rich people would be able to get healthcare for less, and poor people WOULD NOT GET healthcare. A whole class of already abused and underemployed individuals would get trampled on even harder. Society would suffer over the long run because the oppressed underclass, without basic needs met would REVOLT (with good reason; they do not deserve their basic needs, including healthcare, being met any less than someone whose ancestors happened to do well financially).

Re:three words, one hyphen:

[Anonymous Coward]

One large player, Phonak, reported in 2004: "The gross margin reached 59.5% which is almost 500 basis points over the gross margin of 54.8% reported in the same period last year." They've improved that to 66% in 2011.

Certainly the free market isn't driving down the price...

Re:three words, one hyphen:

[Anonymous Coward]

You get what you pay for...

Correct. When you actually can afford to pay for it, you get exactly what you paid for.

Re:three words, one hyphen:

[udachny]

I just explained to somebody in another story how FDA stands in the way of people getting help they need, and here is another silly comment that I am replying to.

For profit health care is the solution to the problem.

The problem is government in health care, preventing all people who want to make a profit in it from participating in the market.

The problem is government intervention into health care, the FDA and all other regulations. Anybody with an EE degree (and even those without, but who learned on their own) should be able at least to try and provide a solution to this problem of expensive hearing aids, and they certainly should be doing it in an attempt to achieve profit, which would only indicate that they are on the right track (and here is another comment explaining why the profit motive is the only moral motive that we know works).

Any high schooler with an interest in electronics and with a pair of hands should be able to attempt and build a device that would help a person with bad hearing, but very few high school students have the money and connections needed to take on the government machine, that stands on his way, protecting the monopolies and oligopolies that government prefers.

Of-course governments prefer monopolies, that is how governments can ensure huge potential monetary sources to run election campaigns and pad politicians' bank accounts.

The for-profit motive is not the problem with the industry, the for-profit motive is the problem with the government.

Re:three words, one hyphen:

[Anonymous Coward]

No, it's the beauty of the Free Market.

Sincerely,
Mitch

Re:three words, one hyphen:

[K. S. Kyosuke]

Can you cite the costs for the same device in non-for-profit countries? I dare ya.

One local manufacturer lists prices between $350-$1200, according to the current USD exchange rate, but I suspect that it's paid for by insurance company anyway.

Re:three words, one hyphen:

[cvtan]

As far as I know, insurance does not pay for hearing aids.

Re:three words, one hyphen:

[LiquidLink57]

True, but it's even more nuanced than that.

Right now, the government gives tax incentives for an employee to get health insurance from their employer. So if my regular income is taxed at, say, 25%, I could either receive $10,000 worth of health care benefits from my employer tax free, or cash, which would mean I would only receive $7,500. So I'd be a fool to not get my health insurance through my employer. So the employee has a government created incentive to favor getting insurance over money. And the more medical prices rise, the "better" it is for me to choose to get the health insurance.

With a huge amount of people incentivized to get this health insurance, and use it as the way to pay for every single medical treatment they receive, and not just insurance against catastrophic accidents (a certain amount of coverage will be mandated under the Affordable Care Act) the more people completely disregard the cost of the care they receive. Do you ever see a list of services and prices posted at a hospital? They're not paying for it, so what do they care what anything costs? If they don't pay (beyond maybe a deductible) why is it worth it for them to price shop? Insurance companies can attempt to do this to a degree by restricting where people can get care or choose not to cover certain things. But these choices are being legislated away as well, and force insurance companies to cover certain things free of charge, hugely distorting the market even more.

Imagine if we bought food like we bought health care. Instead of getting cash, we'd have a government incentive to instead receive an all-you-can-eat grocery card from our employers. We'd walk into a grocery store, and there would be no prices posted, because the shoppers wouldn't care because they aren't paying anyway. Naturally prices would skyrocket as consumers no longer consider price. The government then would come in, point out the skyrocketing price of food, declare a "food crisis," and take over the whole industry. Having caused the problems in the first place.

Look at areas of medical treatment in which the government is not involved. Sadly there are very few of those, but take for example Lasik surgery. Prices for that drop every single year. Why? Because of natural market pressures. People usually pay for that out of pocket, so they naturally price- and quality shop. Lasik establishments are incented to reduce costs and improve quality. And they do.

The problem is not that it's "for profit." The computer industry is hugely profit-driven, and advances in manufacturing and assembly efficiencies drive down costs a huge amount. McDonald's prices don't skyrocket because they're for-profit. The reason problems get solved and consumers get what they want is because people can make profits providing what they want at a price they want, without government intervention. But parent is right. The problem isn't "greedy capitalism." The problem is that we have gotten so far from real capitalism, though we still think that's what we've got, and whenever something like this happens, someone points out capitalism and greed as the problem and insert even more damaging bureaucracy.

Re:three words, one hyphen:

[budgenator]

If you don't mind a behind the ear design, there's plenty of hearing aid work-alikes out there. Hearing aids are FDA medical devices that must be custom fitted and adjusted for the individual by order of a licensed professional, but if you look in the back of the AARP, or the American Legion magazines you'll find consumer devices that look a lot like hearing aids, work like hearing aids, but aren't.

Re:three words, one hyphen:

[Anonymous Coward]

You sound equally, or perhaps greater partisan than the idealogue strawmen you try to conjure.
How many deaths did the Ear Trumpet app cause before the knights in shining armor shut them down?

Re:three words, one hyphen:

[Anonymous Coward]

Um... sortof. It's the old trick of ask for way more than you you want for price, and then when they argue it down, you end up where you wanted it in the first place.
It's not like hearing aids are alone in this. Aircasts with water flow pumps are like $400... they've got about $15 of parts in them.
Crutches, xrays, ultrasounds, the list goes on forever.
It's a major scam and it won't get fixed until there are regulations preventing it.

Re:three words, one hyphen:

[Anonymous Coward]

Were he, and hundreds of thousands other fully capable practitioners, able to come here and just hang out their shingle, you'd see health care costs plummet. But no. The medical profession protects its own from competition by convincing everyone they know best by limiting the number of doctors and med students.

A) Doctor salaries have decreased about 1% per year for quite some time, despite rising demand, leading to a government-created shortage.

B) Doctors aren't paid nearly what patients think, or even what patients think they deserve. Overall, it's an almost trivial portion of healthcare costs.

C) Foreign MDs vary a lot. Many are excellent, many are terrible. The thing is that the US has the strictest standards, so all are required to complete a US residency. Furthermore, the practice of medicine differs dramatically between countries. Foreign doctors generally need to improve on English, familiarize themselves with American culture (actually rather difficult for most), and learn about the diseases common in America (i.e. very different than China).

Re:three words, one hyphen:

[Anonymous Coward]

The forgot the Govt. FDA and other agencies and laws.

Re:three words, one hyphen:

[Anonymous Coward]

Not sure if this would be case, but there would certainly be a lot unintended consequences.

Re:three words, one hyphen:

[CrudPuppy]

That's changing ever-so-slightly, especially for Cochlear implants, because we the deafies are now arguing that *not* covering them is plain and simple discrimination.

IMHO the government should pay for new hearing aids for me, once every 4 years. Before you pass out, let me explain: If I do not have hearing aids, I am deaf enough I cannot hear voices at all, and thus cannot work. I can collect about $2800/mo in SSDI right now if I cannot work. So balance that cost against the cost of new hearing ids every 4 years. AND as an added bonus, you bet your ass the Government would not be paying $3000/aid.

Win, win, win.

Re:three words, one hyphen:

[Chuckstar]

Healthcare would be a hell of a lot cheaper if the government stayed the hell out of it.

It would also be much less effective and much less safe.

The free market doesn't fix everything. In fact, the basis of the current regulatory regime regarding new drugs was originally put in place because a bunch of consumers were killed by a bad drug... with especially painful-sounding deaths... the company never performed any testing with the formulation... and should have known there was a problem in the first place. The story is: Massengil used diethylene glycol as a solvent for dissolving sulfanilamide into an elixir format. Diethylene glycol was a known poison, but the company's chemist wasn't aware of that. Even very simple animal testing would have found the problem.

So how about instead of ridiculing every action the government takes, we all get together and try to limit the useless actions and focus government on the useful ones? Requiring drugs to be tested and shown to be safe and effective is a Good ThingTM. Whether in the U.S. or in countries with weaker regulatory regimes, we've seen time and time again that the free market is simply not up to the task of keeping ineffective or even dangerous drugs from being peddled to consumers. However, some of the detail of how the FDA reviews drugs might be amenable to streamlining (I don't know enough detail to suggest how, but it seems almost certainly probable).

On the other hand, your description of Ear Trumpet's experience with the FDA seems like a Bad ThingTM.

I'll bet if you got 10 Republican and 10 Democratic congressmen together (and could somehow figure out a way of making them ignore the fact they were working together), you could find 20 ways that everyone would agree would streamline the FDA without materially affecting the quality of health care. In decades past I would have said the biggest impediment to such agreements was that no one in Washington really cares to put such effort into low-profile results. That still might be a problem today, but the bigger problem in Washington today is the part I put in parenthesis above -- not only is there a divide that makes it hard to work together, congressmen are actively disincentivized from working across the aisle, in spite of rhetoric to the contrary.

It's too bad, because there are plenty of opportunities to streamline government. Only the Republicans think streamlining is bad because it gives the new streamlined regulations more validity -- "we don't want better regulations, we want NO regulations". Democrats think streamlining is bad because simpler regulations can have larger loopholes -- "regulations should be intricately taylored to each situation so that big business can't slip anything (no matter how immaterial) through the loopholes."

As far as the MD trained in China... the problem with just letting foreign doctors practice here is that the quality of training varies dramatically overseas. The doctors in China who went to better universities and trained in better hospitals are probably on par with U.S. doctors. The ones who went to smaller, regional universities and trained in rural hospitals may not be qualified to practice in the U.S. A written exam wouldn't be able to distinguish, but maybe there's a middle-ground where a few U.S. institutions would be qualified to run 2-year residency programs where foreign doctors' skills are put to the test. The ones that pass get full MD privileges. The ones that don't get kicked down to medical school to start again.

See? There are possible compromises to these things. We really, really don't want a free-for-all in the healthcare system, though. It would be monetarily cheaper, but at what cost in lives?

Re:three words, one hyphen:

[Anonymous Coward]

Because it's obvious economics...people are not price-sensitive when they have insurance. Their co-pay is the same no matter how much the hearing aid costs. This is why many of the European healthcare systems have high copays.

Re:three words, one hyphen:

[Firethorn]

That's not a normal situation though - Last couple times I bought, they'd have dropped the price by a couple thousand if I could have paid cash in full.

It was probably more the way the dude's commission was set up, because otherwise I'd take the loan - then pay it off next month. Living in a state that forbids early payment penalties helps.

Re:three words, one hyphen:

[jellomizer]

We say how bad Microsoft is but they are angles compared to Siemens. The sell pure crap at a lot of money.

Re:three words, one hyphen:

[Arthur B.]

for-profit healthcare

Right, because every other electronic device - the prices of which keep falling - are produced by not-for profits.

Among many reasons are the high costs of medical regulation, liability insurance, the fact that paying with insurance seriously blunts the pressure on prices. But no, let's just say it's "greed" and feel self-content with a non explanation.

Re:three words, one hyphen:

[CastrTroy]

Except that there's plenty of deaf people who cannot use a hearing aid and yet still manage to have a job. Not being able to hear does not mean you can't work. It means some jobs are harder or just impossible (phone support, although I'm sure there's phone support tty operators). There are many jobs where you just don't need to hear to perform the job just fine. Also, if an employer doesn't hire you because of the disability, that is discrimination.

Re:three words, one hyphen:

[tburkhol]

If it were individual, it would be like a car salesman... attempting to charge the highest price, ask you to take out a loan and pay it.

Yes, but if you don't like the car salesman's deal, you have to take the bus. If you don't like the hearing aid salesman's price, you're deaf. If you don't like the surgeon's price, you're dead.

You can't negotiate healthcare on a level playing field, regardless of who writes the check.

Re:three words, one hyphen:

[mcrbids]

Strange how your example is a case of limiting supply to cause prices to climb, exactly as the "non-existent" law of supply and demand would dictate? You might want to read up on what Supply and Demand would predict. Specifically predicted:

If demand increases and supply remains unchanged, then it leads to higher equilibrium price and higher quantity

Re:three words, one hyphen:

[sycodon]

No, it isn't "for profit" per se that causes the high prices. It begins with the way consumers perceive their insurance plan. They see the insurance payment as a sunk cost, and don't really want to spend any less than the maximum that the company will pay. In addition, most people are willing to pay extra out of their own pocket to get better equipment, so the hearing aid companies set their prices to encourage that. The medical device designation is a significant barrier to entry, and so minimizes competition. These factors combine to set the price.

Because I have no mod points, I'm posting the AC's comment because it is spot on.

Re:three words, one hyphen:

[__aarzwb9394]

You sound equally, or perhaps greater partisan than the idealogue strawmen you try to conjure.
How many deaths did the Ear Trumpet app cause before the knights in shining armor shut them down?

My specific response was to "government staying the hell out of healthcare".
The previous poster set up the man for me, straw or otherwise.
Probably not a great deal of harm being done by an ipad app that does a cheap -n- cheerful hearing assessment. Pretty similar to inexpensive reading glasses, I'd imagine.

But please note, the poster above me calls for total removal of government regulation from healthcare, not from ipad apps that check your hearing.

Re:three words, one hyphen:

[sycodon]

Actually, it's because of government sponsored healthcare. The type that is wholly a for-profit enterprise, such as Lasik, consistently gets cheaper. When the government gets involved, the prices go up.

Reposting because it's spot on.

Re:three words, one hyphen:

[nbauman]

Another case in point. One of my students' father was trained as an M.D. in China. The family emigrated to the U.S. and the father had to go through medical school all over just to prove he knew what he was doing. The only thing that improved in med school was his English. Were he, and hundreds of thousands other fully capable practitioners, able to come here and just hang out their shingle, you'd see health care costs plummet. But no. The medical profession protects its own from competition by convincing everyone they know best by limiting the number of doctors and med students.

Healthcare would be a hell of a lot cheaper if the government stayed the hell out of it.

You made a good point, but this isn't it.

China is a big place. They have some of the best scientists and doctors in the world. They also have some of the worst. We need someone to figure out which category a Chinese doctor falls into, before we turn him loose on a public that can't tell the difference.

HARSH TREATMENT
In China, Brain Surgery Is Pushed on the Mentally Ill
Irreversible Procedures Rarely Done Elsewhere; A Mother's Regrets
By NICHOLAS ZAMISKA
Wall Street Journal
November 2, 2007

NANJING, China -- Mi Zhantao, a poor 25-year-old living with his parents outside this provincial capital in eastern China, was battling depression and had trouble socializing. Doctors said he had schizophrenia. They recommended brain surgery.

Mr. Mi's family spent about $4,800 -- the equivalent of four years' income, and more than their life savings -- on the operation, at No. 454 Hospital of the People's Liberation Army in Nanjing. The highly controversial procedure involved drilling tiny holes in the young man's skull, inserting a 7½-inch-long needle and burning small areas of brain tissue thought to be causing his problems.

The surgeon, who operated on Mr. Mi the day he met him, says he has performed nearly 1,000 such procedures, mostly for schizophrenia, but also for illnesses ranging from depression to epilepsy, since the hospital started offering the operation in 2004.

Mr. Mi's parents say the surgery did nothing but leave their son with a partially limp right arm and slurred speech. He continues to be depressed and withdrawn, his mother says. Wang Yifang, the surgeon, says he checked the medical records and, as far as he knows, the patient left the hospital uninjured.

Mr. Mi's mother, Kong Lingxia, 50, says she'll regret the decision for the rest of her life. "I feel so angry," she says. "But I'm really angry at myself. How could I let this happen?"

(more)

http://online.wsj.com/article/SB119393867164279313.html

Chinese pharmacists in the US have generally escaped regulation, under the "dietary supplement" laws, and when the New York City health department investigated some of them, they were selling medicines that were adulterated with lead, Viagra -- you name it. The Chinese pharmaceutical industry sells source material to US companies, but the FDA can't go to China and investigate the manufacturers. As a result, there have been several incidents of people getting sick and dying because Chinese products, whose manufacture the government stayed the hell out of, turned out to be contaminated or deliberately adulterated. The New York Times had a series about that by I think Walt Bogdanich. One batch of children's cough syrup contained antifreeze and killed about 100 children. You want to sue them? The NYT tried to track some of those companies down, and couldn't find them.

I don't think you can find a country in the world that has a successful health care system where the government stays out of it. Very few patients know enough to shop for health care. A doctor has the ultimate high-pressure sales pitch: "You have to do this, or you might die. And you have to do it now." What are you going to do when a doctor tells you that in your 15-minute office visit? Stop and look it up on Google?

Re:three words, one hyphen:

[Imrik]

While I don't think you should get free hearing aids, you should get a subsidy similar to what I get for my eyes. That or eliminate my subsidy. :P

Re:three words, one hyphen:

[mabhatter654]

Two.
Medical Device

Being a medical device means it has a profit killing paper trail.

I suspect that warranty required is one reason the cost is "stepped on". The other reason would be that there is a lot of customer service involved in fitting, moulding for each customer. That makes a high raw material and staffing cost.

Re:three words, one hyphen:

[Imrik]

How would those few thousand deaths compare to the lives saved by proper medical care as a result of lower prices?

Re:three words, one hyphen:

[Culture20]

$15 in parts and $900,000 in costs for FDA regulation compliance.

Re:three words, one hyphen:

[Anonymous Coward]

Yes and no.
You see goverment as a whole, were that big single entity is made of small other entities, and (can you belive this?) people...
Those people in turn, tends to be so gullible as anybody. Corporations, and business understand this much better than us (citizens), and they use it to their advantage.
So, they go to the right person and say, look, we are to maintain bla bla bla(insert whichever argument here), so, we need regulation.
The kind of that regulation is what decides the rules to be used, and guess what? health, layers, real state, and those old profesionals have had a lot of time to press where they needed to get an escenario that fit's them as a glove. Moreover, we have come to take that as it is, after some few centuries.

Moreover, helth is on of those markets where the same device, but with big manuals, and operational limits very well documentes, can be worth 10x. Most of the medical equipment is very expensive because there are just a few person with contacts and monetary back to have their equipment tested to comply with whatever standard the stablishment put into place to keep other out.

So, the tools that have been in use can be used properly, much like a scissor can be used to cut paper or persons. But those old markets make a lot of profit, are very very very closed and they like it that way.

On the other hand, helthcare understood as the service, is _much_ more neded than other services the state is providing. It should, and is in some countries, a state matter, not free to be discussed by corporations. When you base a service on the greed of profit, it tends to get more expensive (because that is profitable) insteado of the opposite. The marked closes on a few players, and we all loose. Health is a very strange market. Players make money with ill persons, so, guess what will happens if you let them play for profit? Well, this is what happens.
Just my two cents.

Re:three words, one hyphen:

[Anonymous Coward]

But you highlight one of the inherent problems with government regulation (which I do not propose eliminating wholesale). It is comparatively easy for the government to come in and say "that's a bad thing, we need to regulate that" but once the regulatory door has been opened the government agency has little motivation to consider cost/benefit analysis in their decision making. They tend to be extremely risk adverse and supportive of the status quo. Your example of Diethylene glycol poisoning seems like a Bad ThingTM that it would be good to have the government prevent, but once the government "wins" that battle and everyone is testing their products properly the FDA is unlikely to take a step back and reduce their regulatory oversight. Afterall, the next Bad ThingTM is just around the corner, and the industry insiders who are buying their bosses actually like the regulations because it keeps anyone who is competitive out. Regulations are always added, but rarely are they examined to see if they are still relevant or ever were useful in the first place.

Re:three words, one hyphen:

[Anonymous Coward]

No, you got fooled. If they ever say something like that again just say "if cash isn't welcome, I'm leaving." Even when they pull back in with a better price start leaving again, obviously, you need to hassle make it sound like you haven't made up your mind, need more time, aren't happy with options installed just make sure no local dealers can meet your demands*, etc. Just come up with reasons to leave your chair. If you can get into your old car and drive a few blocks if you don't get a phone call. Go back in and say you know what that really was a good deal, I would be a fool not to take it. They'll be happy to sell you the car. If they try to raise the price just get out of your chair again. Also, you should try to find a dealer who buys the cars outright from the manufacturer he gets a price that's actually way below invoice** because he's actually buying them and he'll be okay with passing the saving on if you make him do it. Buy your extra warranty out of state over the phone for peanuts, it's worth the extra coverage for under $500 and remember you can buy up to day the first one goes out.

*If the one dealer has the only car configuration you want but won't deal on the price get the VIN and go to another dealership for the same brand, he can do a cross sell for you and he usually will give a good deal just to screw the other dealer out of commissions, it's prefect for him he has no investment in it but gets to place a another sale on the books which gives him a bonus or better cash back.
**Usually, it comes in the form off a rebate or special bonus awarded for actually buying of cars and not just being a regular dealer. and they usually have agreed to buy X cars a month, so they need to sell at least X cars.

Re:three words, one hyphen:

[jwilty]

One of my students' father was trained as an M.D. in China. The family emigrated to the U.S. and the father had to go through medical school all over just to prove he knew what he was doing. The only thing that improved in med school was his English. Were he, and hundreds of thousands other fully capable practitioners, able to come here and just hang out their shingle, you'd see health care costs plummet.

As a US physician who has spent a month in China studying their medical system and seeing firsthand their medical training I can say from experience that this statement is not accurate. There are certainly plenty of capable medical practitioners in China, but the vast majority did not go through the rigors required to obtain an M.D. in the United States. Even in the major cities (Beijing, Shanghai, etc.) most students receive the training equivalent to a Masters degree. In more rural areas it is closer to a B.S. There are certainly many flaws in our healthcare system, but the standardization of training is a major strength. Of course, also keep in mind that medical tests/procedures account for a much greater percentage of healthcare costs than physician's salaries (especially primary care physicians that can just "hang out their shingle"). For example, one MRI costs as much as 10 office visits.

Healthcare would be a hell of a lot cheaper if the government stayed the hell out of it.

If the government stayed "the hell out" of healthcare, then only the richest of the rich seniors would be able to afford care for the inevitable problems that come with aging. What insurance company would accept someone who is likely to have a $30k+ hospital stay in the next 20 years EVEN IF they are completely healthy otherwise?

Re:three words, one hyphen:

[Anonymous Coward]

Sounds like a potential business opportunity.

Pity Americans are too lazy and shiftless these days to take advantage of it.

Re:three words, one hyphen:

[Culture20]

The only thing that improved in med school was his English.

I would hate for there to be a miscommunication with my doctor. "You have positive result!"

Re:three words, one hyphen:

[paddbear]

Most insurance doesn't pay for hearing aids. Those that do only pay a small portion of the total cost.

Re:three words, one hyphen:

[Chuckstar]

I actually agree with your point. But the solution is not "no regulation". The solution is vigilance on the part of those who have influence over the regulatory bodies. To use another "TM", such vigilance is a Very Hard ThingTM, but is unfortunately the Only Reasonable SolutionTM. :-)

I object to the concept that if government just stopped regulating everything would be better. (Even Mitt Romney seems to agree with that point.)

But I also just as adamantly object to the concept that we can just throw in some more regulations and fix everything.

To give a completely unrelated example, there was plenty of regulatory authority in place for the government to have put a stop to the sometimes brain-dead and sometimes predatory lending practices that most people blame for the financial crisis. The U.S. did not need additional regulation after the financial crisis occurred. All the U.S. needed was for the regulators to exercise their authority against the most egregious of the mid-2000s lending practices. (May not have kept a recession from occurring, but would almost certainly have kept it from being the mess we have today.) Instead, what we have today are regulators that are just as timid about actually exercising judgement, but they now have a whole other layer of regulatory requirements they are responsible for. The worst of all worlds.

Re:three words, one hyphen:

[PopeRatzo]

If demand increases and supply remains unchanged, then it leads to higher equilibrium price and higher quantity

If I understand what you're saying, then if "supply and demand" is a law, the companies who artificially limit supply in order to raise prices are the equivalent of someone who breaks the law and gets off on a technicality.

The only thing you've proved is the reason why there can never be a "free market": because we have companies who will profit more by making less of something. Farmers who will burn cornfields in order to raise prices and oil companies who will start rumors of oil field explosions in order to get a bump in the spot price. And there's more profit in destroying your competition than there is in selling a great product.

If the system can be gained by artificial scarcity, then there cannot be a "free market".

Re:three words, one hyphen:

[Anonymous Coward]

I have two top-of-line aids with extensive DSP capabilities. I doubt there is a credible analog product still available. Almost all sold now are behind-ear models with tiny wires to the in-ear speaker plugs. So they are really maintenance-free (outside of hostile ear environment), aside of wax filters (replace monthly) and batteries (replacement frequency inversely proportional to unit size of course--I get about 5 days).

They are incredibly high-tech, you'll find out when you need them. Repeatedly asking "What?" Is far more noticeable than wearing aids.

I've never had health insurance that covers aids, so don't blame them this time. The level of definitively-expressed ignorance and misinformation in many of these comments is of course a hallmark of /.

Re:three words, one hyphen:

[Anonymous Coward]

So how about instead of ridiculing every action the government takes, we all get together and try to limit the useless actions and focus government on the useful ones? Requiring drugs to be tested and shown to be safe and effective is a Good ThingTM. Whether in the U.S. or in countries with weaker regulatory regimes, we've seen time and time again that the free market is simply not up to the task of keeping ineffective or even dangerous drugs from being peddled to consumers.

Right. Better keep those dangerous drugs like cannabis, LSD, MDMA, DMT, coca leaves, opium, mescaline, etc. out of the hands of the American. We know that it is totally safe to use oxycontin, amphetamine salts, hydrocodone, dextroamphetamine, tylenol....

Re:three words, one hyphen:

[AthanasiusKircher]

When you have products that are highly desirable (and if you're hearing-impaired, a hearing aid is highly desirable) then prices will stay as high as people are willing to pay.

Unless a reliable competitor emerges with a similar product and is willing to make profits off of selling volume rather than hiking the price exponentially.

I frankly don't know what is possible for hearing aids, but I do know, for example, that a medication a friend needed to buy supposedly cost $170 at retail for a 90-day supply, and he was asked to pay $45 for a copay for that medication by his insurance. One day when he moved, he decided to transfer pharmacies and went to a local grocery store with a pharmacy. He didn't have insurance at the time, so he expected to have to shell out a lot of money. But, only with the free savings card from the grocery store, he got the 90-day supply for $10, less than 1/4 of his copay with a premium insurance plan! This was for the same generic drug in both cases -- but in the first case an insurance company, a drug manufacturer, and a pharmacy were obviously in collusion, while in the grocery store, the pharmacy had an incentive to sell cheap drugs to uninsured people, so it made a deal with the manufacturer. The grocery store pharmacist didn't even ask for insurance information, because he knew he could give a price better than any copay required on a normal insurance plan.

This is for a "highly desirable" product (in this case, blood pressure medication).

For another example outside of medicine, there was a regional grocery store chain where I used to live whose prices were consistently about 40% off of all major competing grocery stores in the area. I'm not talking about generic items: I'm talking an average of 40% off for the same name brand grocery items. They had only one store in the metropolitan area where I lived, but the aisles were packed almost from 7am-9pm. It wasn't convenient to public transport, but I saw poorer folks taking cabs to get there all the time, because they saved so much, it more than paid for the cab.

You can't get more "highly desirable" than basic food. The other supermarkets in the area counted on the fact that they were more convenient to public transport or that people just wouldn't bother to look at the other store or that people would assume it was the place "poor people shopped." Quite a few people who never shopped there told me that they heard it was "dirty." Yet the opposite was the case -- produce and meat flew off the shelves and was much fresher than any other supermarket in the area. I never saw evidence of dirt or vermin there, but I heard a couple different friends report that they saw mice at one of the "premium" supermarkets near there, and one who reported the mice saw that the food which had been eaten into was not removed from the shelves when she was back there a couple days later. After all, the "premium" supermarkets were always like ghost towns, except for a few hours right after standard work hours, so most people wouldn't even notice.

Basically, if there is a market where people will shop around, some businesses may take advantage of that market by providing a cheaper product. If few consumers actually have a real transaction to buy a product and instead go through an intermediary like an insurance company, there is little incentive for anyone to provide lower prices. In fact, if there is a situation such as in the current national health care bill where insurance companies will be limited to 15% of billed costs toward "administrative fees" (i.e., where the profits come from), there is actually an incentive for insurance companies to drive costs UP, since that's the only way they can skim more money off the top.

Re:three words, one hyphen:

[AlphaWolf_HK]

Or perhaps, it's just "hip" to buy an iphone, and the high price is why people want them.

When Gucci lowered the prices on their designer clothing, their sales volume dropped. Were talking volume here, not profit. By raising the prices again, they actually sold more clothing.

When you put a high price on something, in many cases it can make people desire it more. I guarantee that if apple dropped their prices, they would probably sell less as well because it wouldn't be this trendy thing that only the "hip" or
"sophisticated" people have any more.

Anyways, over 500 years of market history will tell you that supply and demand isn't fiction. Only a die hard communist chooses to ignore that.

Re:three words, one hyphen:

[gstoddart]

The iPad mini is evidence that competition doesn't reliably drive prices down.

Not true, competition on the low end of tablets cause Apple to release a smaller iPad, thereby driving down the overall price of iPads by offering a cheaper model.

But on the low end, you have my wife's Playbook (which she gets routinely pissed off at and overall finds not as good as she'd hoped) and my brother's cheap-assed Android tablet (whose clock stops when the device is powered off).

I'm sure there's lots of better tablets than those examples, but it's a matter of perceived value. The proverbial Mr. Smith drinking beer and eating nuts will buy those in proportion to the value they assign. Or, so goes the theory.

So the people buying iPads feel they're getting some improved quality ... I've got one. I quite like it. But I'm sure there's other lovely tablets out there too. But I can play the digital copies of movies I buy on my iPad without being sued for copyright infringement. And, it's convenient since I don't need to waste time trying to rip it (and, yes, of course you can do this on other tablets).

There is no "law of supply and demand". It's a fiction.

It's not a fiction, but it's not an immediate and absolute thing either. There's other things to consider.

There's only so many people really making the screens for touchscreen, and they're all suing one-another. Adding a new factory likely takes years and billions of dollars, and the suddenly huge market for them is still comparatively new in terms of being as widespread as they are now. Give it a few years, and there should be some downward pressure.

And, it's not unprecedented for companies to collude to keep prices artificially high -- it's not in their interest to have prices drop. OPEC does it all the time when they manage outputs -- it's done to maximize profits.

Then everything nowadays is encumbered by patents, and everybody wants to sue everybody into the ground. So trying to make it likely means vast legal resources just to figure out what to license from whom.

The problem with economics is often that people believe they can predict with 100% certainty what will happen, and being certain of their certainty, they try to manipulate things to their advantage -- high frequency trading in the stock market for example. That's designed to skim off the top as quickly as you can. Again, it's all about the profits.

It's not so much as it's a "fiction" in that there is some sound observations in it (which in general hold true) but a series of assumptions and observations get built up into a Model that can be used to make Predictions. Then it usually becomes a belief system, and that's where the fiction really begins (both Communism and Capitalism have their own fictions, it's not limited to just one).

Hell, in a sense, money is a fiction -- albeit it a very real aspect of our lives. But, I wouldn't disagree that the people who claim to understand how the economy works don't really know as much as they think.

And that begats politics ... ;-)

Re:three words, one hyphen:

[Anonymous Coward]

Correct response here: walk away! Amazing how quick they'll see reason!
As I was taught: "never enter a negotiation unless you're willing to walk away. Else, all you're negotiating is your terms of surrender."

Re:three words, one hyphen:

[Anonymous Coward]

Nope. Hearing aids are excluded from almost all for-profit health insurance plans. Medicare will chip in around $500 once every five years.

Re:three words, one hyphen:

[Anonymous Coward]

Hearing aids aren't covered by insurance in the US.

Re:three words, one hyphen:

[Chuckstar]

Just because a regulatory regime does not result in a perfect outcome, doesn't mean it provides zero value to society. Not all approved drugs are perfectly safe. In fact, few drugs are perfectly safe. Tylenol is the only non-steroidal, non-opioid drug I can tolerate, for instance. For me, it's the safest option for treating pain (in suggested doses, Tylenol is less likely to create other problems than either steroid or opioid-based pain killers). Oxycontin has problems, but is still superior to many other opiate/opioid options.

As far as the illegal drugs, in my opinion there is room for legalizing some (if not all) of those. But isn't that a separate discussion topic from the costs/benefits of the FDA's regulatory regime in the healthcare market?

Re:three words, one hyphen:

[fahrbot-bot]

Healthcare would be a hell of a lot cheaper if the government stayed the hell out of it.

Perhaps, but not necessarily better or safer.

Without regulations, companies would only pursue standards, safety and efficacy if it promoted their bottom line - profits. (Remember that public corporations are beholden to their shareholders, not customers or employees.) Before you reply that they would go out of business otherwise without those considerations, consider that companies routinely preform cost vs. risk analysis to determine whether it would be cheaper to make a good, safe, effective product (or fix a broken one), or pay fines and litigation costs. Of course, without any regulations there would no basis for victims, I mean consumers/customers, to complain or sue...

Government and regulations have their place, especially in healthcare. If you can't understand that, then, quite frankly, you're a moron. (No offense.)

Re:three words, one hyphen:

[tmosley]

No, two words. Fascist healthcare.

https://mises.org/daily/4276

Re:three words, one hyphen:

[shiftless]

But please note, the poster above me calls for total removal of government regulation from healthcare

Which is exactly what should happen. I don't need the fucking government to protect me from myself. What the fuck the point of a trademark, if not to give me (a supposedly free citizen) the information I need to decide whose services I choose to patronize?

I DONT NEED THE MOTHER FUCKING GOVERNMENT TO TELL ME WHAT I CAN OR CANT BUY, OR WHO CAN AND CAN'T DO BUSINESS.

Re:three words, one hyphen:

[Anonymous Coward]

Are you a nincompoop, or just retarded?

Re:three words, one hyphen:

[tmosley]

Even if they cost $20? -15% a year is way different than +8% a year.

Re:three words, one hyphen:

[shiftless]

Unintended consequences? What the fuck do you think we're dealing with now? Any time a country full of dumb asses thinks they can regulate away their problems through government, there are always unintended consequences. What, do you think the healthcare system problems we are experiencing now are from a free market?

Re:three words, one hyphen:

[tmosley]

Sweet. I have a radish to sell you. It only costs $100,000,000. No such thing as supply and demand, so you shouldn't have a problem with that.

Re:three words, one hyphen:

[shiftless]

Foreign doctors generally need to improve on English, familiarize themselves with American culture (actually rather difficult for most), and learn about the diseases common in America (i.e. very different than China).

I imagine "fat-assedness" and everything related to it (heart problems, diabetes, etc) tops the list.

Re:three words, one hyphen:

[Anonymous Coward]

What an obtuse comparison.

Re:three words, one hyphen:

[shiftless]

The free market doesn't fix everything. In fact, the basis of the current regulatory regime regarding new drugs was originally put in place because a bunch of consumers were killed by a bad drug... with especially painful-sounding deaths... the company never performed any testing with the formulation... and should have known there was a problem in the first place. The story is: Massengil used diethylene glycol as a solvent for dissolving sulfanilamide into an elixir format. Diethylene glycol was a known poison, but the company's chemist wasn't aware of that. Even very simple animal testing would have found the problem.

So, mountains of paperwork and regulations later, have things improved any since then?

Do you really think government is the solution to your problems?

Re:three words, one hyphen:

[tmosley]

That's like saying that pilots break the law of gravity. The laws of economics aren't enforced by policemen, they are a result of natural human interactions.

Funny how you attribute the perverse behaviors of individuals under the influence of government imposed regulations and incentives to the "free market". If a farmer in a free market burned his crops, he would drive the price up for all the other sellers of that crop, and he would lose market share. Anyone who did this regularly would go out of business. You need to stop confusing commodities like food crops with brands like Apple.

Re:three words, one hyphen:

[Voogru]

Cell phones are for-profit, and get better and cheaper every year. They also don't cost $2000.

Computers are for-profit, and get better and cheaper every year. They also don't cost $2000 unless you get an absurd one.

The difference?

The government doesn't interfere as much with these markets, so they're allowed to function.

Re:three words, one hyphen:

[Voogru]

Have you ever thought that it's because it's not a free market?

Re:three words, one hyphen:

[tmosley]

https://mises.org/daily/4276

There is more than one surgeon in the world.

Re:three words, one hyphen:

[shiftless]

All the problems you listed are due to ignorance. Regulation is a bandaid; the cure is education.

Re:three words, one hyphen:

[tmosley]

50 years ago, insurance was rare, and medicine was cheap. Today insurance is everywhere due to tax favored status, and medicine is expensive. The correlation is very high.

Re:three words, one hyphen:

[shiftless]

If the government stayed "the hell out" of healthcare, then only the richest of the rich seniors would be able to afford care for the inevitable problems that come with aging. What insurance company would accept someone who is likely to have a $30k+ hospital stay in the next 20 years EVEN IF they are completely healthy otherwise?

What entitles each and every person on the planet to a $30k hospital stay, at taxpayer expense?

Re:three words, one hyphen:

[Anonymous Coward]

very true. I wonder what the companies profit margins are.

Have purchased 3 sets of hearing aids in the US. Just purchaswd an aid from china at less than 10% of the cost of one of them.Working, so far, satisfactorily.

Re:three words, one hyphen:

[dead_user]

Ah, but I bet you could sell that radish, and millions more like it, if you stuck an organic sticker on it and priced it at 300% the normal price.

Re:three words, one hyphen:

[Anonymous Coward]

They're not covered by insurance.

Re:three words, one hyphen:

[tmosley]

Currently, we are paying for more oppression and waste.

Re:three words, one hyphen:

[__aaltlg1547]

It IS manufactured for less than 10% of the price.

Re:three words, one hyphen:

[tmosley]

Why? Healthcare was freely available to the poor prior to government involvement in the industry. Doctors would even make housecalls to tenement houses.

Free markets work, no matter what you say about them. If they didn't, then computers would be ultra expensive and unavailable, while the Post Office would make money.

Re:three words, one hyphen:

[Anonymous Coward]

Don't be so sure. My vet recently decided to start pushing insurance. Interestingly enough, all of the services the insurance covers have all gone up in price, despite not having gone up in years, nor any other services having gone up in price. Of course, if vet insurance companies reimburse like major medical does, this doesn't surprise me at all. You see, your insurance company negotiates with your doctor based on two major numbers, their usual and customary rate (UCR) and the current reimbursement rates in Medicare. In both cases, normally the insurance company negotiates to pay some percentage less than the UCR. So if your doctor charges $100 for an office visit, the insurance company instead offers $80, which includes the patient co-pay. Now, the insurance company is incentivized to reduce costs, so every time the contract comes up for renewal, they're going to try to lower that reimbursement rate (and will usually win, since the profitable customers are usually the ones with insurance). On the other hand, the doctors office is incentivized to earn more money to make up for the losses incurred by accepting insurance, among other increasing costs. So your doctor raises his UCR to $120 per visit, so that when the contact comes up for renewal, even though they're going to get a smaller percentage of UCR, they won't lose nearly as much. This is why even though an inflation adjusted cost of a child birth and 4 night stay in the hospital should only be ~$1000 today, it's actually tens of thousands of dollars if your unfortunate enough to pay in cash, and even with insurance is still close to 10 grand.

So yeah, don't be so sure insurance is the magic pancia the media and the government has made it out to be.

Re:three words, one hyphen:

[Anonymous Coward]

Which is nominally true, but most of the professionals are, frankly, incompetent and could be replaced with a ouija board picking letters to set the dials to. I know of *one* audiology team that tried to actually publish specifications and standards that were based on repeatable results, and they were forcibly silenced by other departments all over the medical world who wanted them to *shut up* and let them continue pulling in the fees.

Hearing aids have to turn the roughly 70 dB of comfortable sound levels into the roughly 40 dB or less of loud enough to hear, but not so loud it hurts that a deafened person might experience. Remember, loud sounds hurt mildly deaf people *more*, not less, than someone who is not deaf at all. (This is why sensitivity to loud noise is actually a sign of deafness.)

So, most modern complex hearing aids use a fancy gain control, which is an expensive chip or a *very* expensive amount of wasted digital processing, to reduce the gain very quickly when loud sounds start, and slowly restore the gain as the environment is quiet. This distorts the hell out of "plosive" sounds, and is one of the major reasons hearing aids suck so much, Simply setting them to a maximum sound level, letting them clip loud sounds, and turning up the gain so soft sounds are barely perceptible is very effective, and was described by Licklider roughly 50 years ago, and is extremely cheap and effective to do.

But *noooooo*, they have to invent special models of how they *wish* it worked, and spend bazillions of dollars digitizing it, reducing the digital sampling rate to reduce power drain, then burning 3 times the power with digital analysis trying to re-invent the data they already threw away. And it *does not work!!!!* The old analog hearing aids with a tenth the circuitry used a fraction of the power and *worked better*, as long as they aren't tuned by a monkey who'd serve humanity better if they were flipping burgers.

Re:three words, one hyphen:

[aaarrrgggh]

Spot on. It is the favored tax status that does it.

Our accountant advised us to start a closely held insurance company (not medical) to cover all our life, general and professional liability needs. It is an amazing scam...

Health "insurance" though isn't really in the same category. (Well, scam, but...)

Re:three words, one hyphen:

[Chuckstar]

If you think drugs and medical devices aren't safer in the U.S. (and other developed countries with similar regulatory regimes) than in countries without FDA-like regimes, then you're just not paying attention.

But don't let facts get in the way of your ideology.

There are some problems that only government can fix. The market didn't stop GE from dumping PCBs in the Hudson river (which they'd been doing for 30 years), the government did. The market didn't stop Merck from selling Vioxx, the FDA did. Yes, Vioxx slipped through the FDA's system in the first place. That just means the system is not perfect. It doesn't mean we'd be better off without it.

Re:three words, one hyphen:

[Anonymous Coward]

Hmm.. Interesting but not applicable to this argument, which is typical of internet discussions. I have paid 100% out of pocket for hearing aids gor 30 years. 100%. Thousands of dollars. And I have had what is considered damn good health insurance. Most insurers do not cover aids at all. And if you think they are unnecessary, you don't have a hearing loss and are clueless. I don't know why they are not covered, but they aren't and they are damned expensive. And no, I have no idea why they would be expensive. Except for the simple fact that the people selling them have you by the short hairs.

Re:three words, one hyphen:

[pepty]

>but take for example Lasik surgery.

The principal cost for Lasik surgery is equipment leasing/licensing fees. The principal cost for most medical procedures is skilled labor.

Re:three words, one hyphen:

[Anonymous Coward]

How would those few thousand deaths compare to the lives saved by proper medical care as a result of lower prices?

You're begging the question, specifically that the care offered at the lower price would be proper (and therefore life-saving).

Re:three words, one hyphen:

[Anonymous Coward]

It would also kill and con even more people. Yay.

Re:three words, one hyphen:

[Anonymous Coward]

I see we have someone here who doesn't know what a cite is. For shame with such a low UID.

Re:three words, one hyphen:

[Anonymous Coward]

No, we don't. The US has the highest healthcare costs and among the shittiest health care outcomes of any 1st-world nation. If we got what we paid for, everyone would have Canadian-style health care and we'd still be paying half what we are.

Re:three words, one hyphen:

[Anonymous Coward]

for-profit healthcare

I call BS. Lasik surgery is for-profit and is not covered by (most, if any) insurance plans yet has remained relatively price stable for a decade.

The fact that neither insurance nor the government (aside from health regulatory aspects, ie. no "free, universal LASIK" bullshit) is exactly why this is; it has nothing to do with profit, other than the cost being what the market (read: consumers, with no middlemen) will bear. Heck, LASIK prices even dipped in 2008/2009 when the economy tanked.

Re:three words, one hyphen:

[MagikSlinger]

If everyone paid out of pocket, I can assure you it would be way cheaper.

Like pet veterinary care.

There's a much simpler, basic reason: most people believe the $1000+ hearing aids are better. They aren't really, but that is the value seniors and other place on them, and no manufacturer wants to leave money on the table. Even seniors without insurance would want to pay that price because they believe quality has to cost that much. If they bought a $300 model, seniors would be lobbying their kids for the $2000 model.

So much of health care spending is 'irrational', and as long as our comfort and longevity are on the table, we'll spend what ever it takes even if it is out of our own pockets.

Re:three words, one hyphen:

[epine]

Healthcare could be a hell of a lot cheaper if the government stayed the hell out of it and unsupervised free enterprise doesn't collude to roger the consumer over a barrel. If their original business model was regulatory capture, you think that will change because you cross out the government term? The government already does a rather poor job of enforcing its monopoly on collusion.

Nearly every business given its choice would source its inputs from a non-collusive market and sell into a collusive market. There's a huge business opportunity if you have the balls to break a non-collusive market, and buy up all the pieces. All of this leads to a decrease in business certainty within the business environment. This has no impact on business efficiency ...

In studies of corruption levels, societies where graft is consistent and predictable do fairly well, even if the graft is fairly significant. Economies where you have no way of knowing the magnitude of the next shakedown tend to spiral down the drain pipe. The worst economies want more government (which would help them become good economies) and the best economies want less government (which will help the wealthy retire to private islands) leaving the schmucks behind to execute effectively in a wild-west business environment. This goes well for a while.

Re:three words, one hyphen:

[im_thatoneguy]

Yeah and 50 years ago people just dropped dead or 'walked off' injuries.

My mom just broke her wrist. Something like $25k in medical bills later she has full wrist mobility. 50 years ago she would have simply had it set and like my Grandpa would probably have pain and immobility the rest of her life.

Re:three words, one hyphen:

[Toonol]

The millions of inexpensive and increasingly competitive android alternatives to the ipad are clear proof that competition drives prices down.

The problem with the healthcare market is that (1) it is too highly regulated and (2) there is no real marketplace because customers are insulated from the true price by layers of insurance and benefits.

Re:three words, one hyphen:

[Harvey Manfrenjenson]

Another case in point. One of my students' father was trained as an M.D. in China. The family emigrated to the U.S. and the father had to go through medical school all over just to prove he knew what he was doing. The only thing that improved in med school was his English. Were he, and hundreds of thousands other fully capable practitioners, able to come here and just hang out their shingle, you'd see health care costs plummet.

Sure you have the details straight? Normally, all that a foreign MD would have to do is complete a medical residency and pass a few exams, and (s)he's ready to hang out a shingle. In fact it's done all the time (something like 20% of US physicians graduated from a non-US medical school).

But I agree with you about the FDA's harassment of EarTrumpet. Absolutely fucking moronic. I notice that they still sell EarTrumpet, but they had to remove certain features because of the FDA...

Re:three words, one hyphen:

[Anonymous Coward]

True, but your implication is that correlation = causation. It might be but it cannot be stated with certainty, on the basis of your statement, that it is so.

In fact we know that labour, usually the single most expensive thing in running any organization, has gotten much more expensive in the last 50 years. This is likely a major part, if not the major part, of the explanation.

Re:three words, one hyphen:

[darkmeridian]

Doctors and hospitals don't want to look like the bad guys, so they'll always dump on lawyers and malpractice lawsuits. But consider that hospitals get paid for each scan and each test that they perform under our current fee-for-service regime. In other words, the more you do, the more you get paid. Not surprisingly, in a free market, you'll see lots of services. Insurance companies try to deny payment for "unnecessary" services, but that's when doctors will trash insurance companies for rejecting life-saving services.

Also consider that the AMA has commissioned studies proving that there are too many medical malpractice lawsuits. But every study commissioned on the matter has concluded that medical malpractice causes far more damage than is recovered in malpractice lawsuits. There are many cases of malpractice where the person dies and no one is around to sue, or where there is malpractice but the case isn't clear cut enough to convince a jury, etc. Lawyers have to front huge expenses in a malpractice case because expert witnesses (doctors) are crazy expensive. So only the "best" cases go to trial. That means, paradoxically, that sometimes clear cases of malpractice won't get tried because the victim was too old and too poor, and died too quickly so you can't sue for lost earnings, or pain and suffering.

So it's a complicated issue. Just don't take the simple narrative that doctors are all saints. Assume everyone is only human and start from there.

Re:three words, one hyphen:

[AmigaBen]

Shame on the developers for rolling over like that.

Re:three words, one hyphen:

[Anonymous Coward]

This is one of the best thought-out comments I've ever read on /. Imagine... there might actually be merit in a range of viewpoints on the problem and the solution!

Re:three words, one hyphen:

[Toonol]

You're missing the principle.

If I make lots of hats, and lots of people want hats, I might be able to charge $20 each. If I decide to make few hats, I might be able to charge $50 each. That is what Apple is doing, and it's a clear consequence of supply and demand.

Another clear consequence of supply and demand is the fact that other hat-makers will see the opportunity, make hats, increase the supply, and allow people to purchase cheap hats... except for the idiots that are demanding overpriced hats. That again is supply and demand, and that again is what is happening in the marketplace in which Apple resides.

Neither strategy is cheating, any more than choosing a different material to build a house is cheating.

Re:three words, one hyphen:

[AK Marc]

Supply and Demand fails in this case because there is no equilibrium. With health care coverage, demand is inelastic. If it costs the insurance company pays for it, then if it's $20 or $20,000, I don't care. I "paid" for it when I paid my premiums, what the insurance company pays for it doesn't affect me. It's against my best interests to shop price. So changes in price will not affect demand, violating "supply and demand".

Re:three words, one hyphen:

[tmosley]

I said no such thing. And NOTHING is certain. p does not equal 1 at any point within the known universe. That doesn't mean we can't notice trends and make predictions based on them.

Also, labor has not gotten more expensive, money has gotten cheaper. Price wages in non-dilutable currency ie gold, and you will notice a couple of trends, with an interesting junction between them. Look up the time of the sudden change with regards to monetary policy, and you will find the cause.

Re:three words, one hyphen:

[DerekLyons]

I wouldn't be surprised if competition wouldn't drive prices down so much that most people who have insurance right now, would be able to afford them (crappy Wal-mart grade models close to what people pay right now for the insurance copay which last maybe a few months). In that scenario (which might be too idealistic), some people wouldn't be able to get them anyhow, same as now people without insurance don't have much option.

There, fixed that for you. For prices to drop, costs have to drop too.

Re:three words, one hyphen:

[Anonymous Coward]

Don't kid yourself. This is NOT a case of insurance coverage driving prices up. Most standard insurance plans won't cover hearing aids, glasses or contacts. If some did--especially medicare--even if they covered only a fraction of the cost, they would bring some muscle to bear on a bloated industry to force prices down.

Re:three words, one hyphen:

[AK Marc]

But the law doesn't work except in a free market or one sufficiently close to it. It predicts the best price for maximum revenue and maximum profit (not the same price) and that prediction doesn't work when competition is artificial (subsidies or high barriers to entry).

Re:three words, one hyphen:

[akgooseman]

A battleground medic fresh back from the sand wouldn't be my first choice of healthcare provider if I were having a heart attack. Not only do they not have the certifications, they don't have the training to provide care in a non-trauma civilian situation. Bring-em-on if I get shot, but that's not going to provide enough employment for returning Army medics unless gang wars really heat up.

Re:three words, one hyphen:

[Impy the Impiuos Imp]

Private insurance or medicare. The same issue occurs with respect to glucose meters. Anybody buying it themselves has long since gone to True Track or some other equivalently cheap thing. Yet companies continue to make new ones that are more expensive with test strips that are closer to a dollar a strip instead of 50 cents. Why?

Government will pay for it and has a declared amount they'll pay. Companies design products to suck on that tit, and provide it to you for "free". Note this also keeps the rate the government pays up because who wants to murder people with draconian cuts and forcing you to go to a cheaper meter?

Re:three words, one hyphen:

[Anonymous Coward]

>The principal cost for most medical procedures is skilled labor.

Really?

Heart surgery costs at least $25,000 in the US, if not sometimes as much as $250,000 (incredibly rich people can pay over a million if they want ritzy digs). You spend about 10 hours, tops, in surgery with 5 well paid surgeons. Let's say they make $250,000 salary a year each and that (HA! As if!) they work 40 hours a week (chances are it's closer to 80, which actually makes their income per hour go down if they're salaries). That's $120 an hour. 50 x 120 = $6000 in labour. Now, we know for a fact the rest of the people directly involved in your treatment in the hospital are making peanuts, just ask any nurse. So we'll be generous and throw in another $4000 for their time and effort during your recovery.

We haven't reached $25,000 yet. Where is the rest of the money? Heck, let's just say those surgeons spend an entire week figuring out your surgery, and that there's twice the number of well paid staff helping them out for an entire week. 400 x $120 = $48,000. Sure, more than $25,000, but it's still nowhere near the 1/4 million some have to spend on their heart surgery. And you have to admit, we're getting ridiculously extreme with the labour involved here. 400 hours--you could have a doctor personally dedicated to you and nobody else for over 2 months with that much labour.

It just doesn't add up. And I overinflated this to the extreme. A simple cardiac operation takes about 2 hours of surgery and doesn't take 5 surgeons at the same time, just 2. If you're hitting up 5 surgeons and 10+ hours, chances are extremely high you're pretty much dead. Here's an idea of how many people are directly involved in surgery, and the assistants are making a measly $25 an hour (hey, think about it, these people are in there keeping shit from falling inside you and killing you, they're worth more than that):

http://www.time.com/time/health/article/0,8599,1931481,00.html

Re:three words, one hyphen:

[microbox]

There is no "law of supply and demand". It's a fiction.

Sure there is. You must factor in the elasticity of demand, and the barriers to entry for supply.

Re:three words, one hyphen:

[Anonymous Coward]

bullshit, fuck you

Re:three words, one hyphen:

[destiny71]

'fraid not.

You ever see an insurance plan that covers hearing aides?

I need a pair, and looked into it. When I brought up insurance coverage, the doctor basically laughed, and said 'We'll see of yours has hearing aide coverage, but I doubt it.' Sure enough, nope. Since then, I've talked to many others, and found no one with hearing aide coverage.

And a sub $1000 one from Amazon does not provide enough power for my level of hearing loss in one ear. Classified as 'profound' Just upping the power would result in feedback. The expensive ones have programmable digital processors that amplify different levels at different frequencies. Cheap ones have nothing like that, just a mic, amp, and speaker.

Re:three words, one hyphen:

[BooMonster]

Indeed. All the people who are hating on the free market forget that people have the choice to buy a New iPad 2 for $600 or a COBY Kyros Internet Tablet MID7012 4 GB off amazon for $66.

In fact, if you really just need a small microphone with a small speaker that plugs into your ear, you can just get a Listen Up! sound amplifier that looks like a bluetooth headset for less than $30.

If the only place you went to shop for a tablet was to talk to the manager of Best Buy, he would sell you an iPad.
If the only place you go to shop for a hearing aid is the doctor's office, you'll get a Phonak Ultra or a Unitron.

Especially if "someone else" is picking up a large part of the tab.

Re:three words, one hyphen:

[BooMonster]

My neighbor sells me all my radishes. His secret? He moved the headphone jack to the BOTTOM!

You have to differentiate on something other than price if you want to charge a premium. Gucci differentiates by cachet. Your radishes just don't have it.

Re:three words, one hyphen:

[caseih]

The app appears to be for sale right now, so any troubles with the FDA must have been resolved. I did a quick google search and was unable to fund anything about this FDA action. Is there a news article somewhere that talks about exactly what the FDA said and did?

Re:three words, one hyphen:

[Anonymous Coward]

I recently got off a drug that cost $200 a month for insruance co-pay and they insisted I went to their own by phone pharmacy or the co-pay would have been a lot higher. I wasn't allowed to shop around, and from my understanding the actual cost of the drug was $38k for a year's worth (I guess around $3k for a month).

I have very little sympathy for people's durg co-pays anymore. $175 for 3 month supply is nothing.

Re:three words, one hyphen:

[BooMonster]

And 50 years ago, she would have simply had it set and like your Grandpa would've handed down an inheritance to you.

Your Mom just spent your inheritance on her wrist. I'm trying not to make a moral judgement here. We, as a society, have decided that there is no amount too high to spend on our bodies, even if we have to lay the debt at the feet of our children's children's children.

Re:three words, one hyphen:

[Anonymous Coward]

This is the hidden tax of MediCare/MedicAid, they pay so little that the cost must be pushed elsewhere, usually to privatly insured patients.

Re:three words, one hyphen:

[BooMonster]

We are paying for the healthcare of the entire world. You think that companies would go through 100 trials each of 100 drugs to find one that works, if the one drug's profits didn't pay for the ten thousand trials?

Re:three words, one hyphen:

[Anonymous Coward]

Radio Shack used to sell an in-ear hearing aid like device for way less than $100. If I remember correctly, it had a foam coating that molded itself to the ear. I can't say how well it worked though.

I am sure that there are mny people who could benefit from such a device that cost $250.00 or less.

Re:three words, one hyphen:

[AK Marc]

Worse than that, the insurance company makes more profit the more the hearing aid costs. The system is pretty broken, so broken that they never talked about the system when trying to change it because the "fix" kept the worst and made the worst parts bigger.

Re:three words, one hyphen:

[AK Marc]

Yup, and I took out the loan, and paid in full the first opportunity. I got my discount, and they got their bonus, and the finance company got screwed for funding commission for a loan up front.

Re:three words, one hyphen:

[BooMonster]

Truth!

One of our biggest problems is that the government has so many rules and regulations to enforce, that they have to pick and choose and delegate. The number of laws has risen, the number of inspectors has fallen, and the SEC is watching porn instead of addressing HFT.

Take your field of expertise. Think about what the government does with it, how poorly they understand it, how worthless, counterproductive, and contradictory they are, and how badly the agents address it. Now extrapolate that to every aspect of and every level of our regulatory culture.

Re:three words, one hyphen:

[houghi]

So you are saying if government would not be involved, I would get money if I went to the doctor?
I now pay 5EUR for a doctors visit. I pay 2 or 3 EUR for my medicine for a 90 day period.

So just because government is involved does not mean it will increase prices.

e.g. government is working more towards generic drugs, instead of the branded ones. Sure the companies are moaning AND are lowering their prices. You can still have a branded one, but it might that you need to pay for it yourself.

If anything, it made people aware that they could ask for generic ones and doctors often already provide them. I even went to a pharmacist who told me he could give me a cheaper generic alternative.

Re:three words, one hyphen:

[flimflammer]

You don't have to look very hard.

Re:three words, one hyphen:

[nbauman]

Education? Do you think the Chinese chemists and American pharmacists didn't have enough education?

Do you want to send every medical consumer to medical school? That's how much knowledge they'd need to be informed purchasers in the free marketplace.

You'd need at least the knowledge of a nurse to make informed decisions in the health care marketplace. That's at least two thousand hours of classes.

One critical assumption of the free market is that people can make informed decisions. Most patients can't make informed decisions. That's why the free market doesn't work in health care. Whatever problems government regulations has, without it people would (and used to) get ripped off.

Re:three words, one hyphen:

[SirSlud]

Holy fuck, did you just equate the law of gravity with ... laws of economics? You mean the equation that hasn't changed since the dawn of the universe with .. what the fuck, a law of economics?

Re:three words, one hyphen:

[SirSlud]

It also doesn't apply to things people can go without and things people cannot go without. That is a sliding scale. I wish people would get it through their skulls that free markets are not free when consumers are not free to not participate at all.

To say nothing that market sellers have every reason to try and make those markets as non-transparent as possible - people do not magically gravitate towards honest sellers any more than they magically gravitate towards some kind of mathematically pure value. You know why advertising, marketing, customer relationship management, etc exists? You are easily manipulated. We all are. Doesn't matter that much when it comes to luxuries. When it comes to what should be basic needs, you really don't want every market seller to realize that 20% of their customer base accounts for 80% of their profits.

Re:three words, one hyphen:

[DrFalkyn]

It's not only this. Insurance also drives prices up for regular consumer. If everyone paid out of pocket, I can assure you it would be way cheaper.

Health insurance doesn't cover a dime for hearing aids. Everyone pays out of pocket.

Re:three words, one hyphen:

[SuricouRaven]

Don't forget fungibility. That's a big concern whenever you're comparing manufactured goods or anything with a brand name. An the impact of advertising, a highly effective process by which buyers are often manipulated into making decisions other than what basic economic theory would consider the most rational.

Re:three words, one hyphen:

[Anonymous Coward]

They'll usually take it. The reason being that they ask for more than what they expect to get. Basically insurers have a secret amount for each whatever that they're willing to pay, if the hospital bills for less than that, the insurer pays the bill. If the hospital asks for more than that amount, the insurers tells them that they'll pay $x and the hospital takes it.

Because of that, the bill is always well above the real cost of the procedure and will include every single thing that an insurer could possibly pay for so as to get the maximum amount for the procedure.

As a result, they'll usually be willing to knock off a fair amount of the bill more or less just because you asked about it. Of course that will depend on the doctors and the hospital some are more greedy than others are.

Re:three words, one hyphen:

[SuricouRaven]

In the 'ideal' free market, competition will drive prices to marginally higher than the cost of production. In the real world that sometimes happens (Why you can buy a decent mid-range laptop for £300) but there are many circumstances which can cause prices to be much higher.

Re:three words, one hyphen:

[baboo_jackal]

Wrong answer - Medicare. See, when your primary consumer is the government, you're going to just end up getting more and more expensive stuff, because there's nobody asking for cheaper solutions. Sure, they may be trying to cut costs, but there's nobody really clamoring for cheaper. They're just going to try to bargain for whatever the industry serves up as "the best," which also happens to be the most expensive, cutting edge version of whatever they sell. This is, in fact, the reason that medical technology in general is getting more expensive, while all other consumer goods are getting cheaper. Need more proof? Look at televisions. You can always spend thousands of dollars on a television - you've always been able to, in fact, even when that three thousand dollar TV was a 720p 32-inch flatscreen. Now, the three thousand dollar TV is, I don't know, a 60" LCD with 3D. But you can also always spend a few hundred bucks and get a pretty decent TV. And that few hundred bucks is always buying you a better and better TV. That's because there's *demand* for the less-than-cutting-edge products. When there isn't that demand, all you'll get are the cutting-edge products, which will be more and more expensive. This is what you get when you're regulated out of beign able to provide surely less effective, but more economical choices. I can already hear the nerf-world argument: "But this is *medical* stuff, and lives are on the line, so we always want the best, cutting edge technology!' Sure, and as long as you cling to that argument, please don't complain about ever-increasing health care costs, or blame the eeevil corporations for (gasp!) giving you exactly what you're asking for.

Re:three words, one hyphen:

[Anonymous Coward]

"Anyways, over 500 years of market history will tell you that supply and demand isn't fiction. Only a die hard communist chooses to ignore that."

That same history tells you that you there are multiple other factors that determine price: (near) monopoly, information-asymmetry, cartels, price hiking. Only a die hard free market fundamentalist would ignore that.

Re:three words, one hyphen:

[Darinbob]

No, it's because every hearing aid is essentially hand made and customized.

Re:three words, one hyphen:

[Anonymous Coward]

Or perhaps, it's just "hip" to buy an iphone, and the high price is why people want them.

When Gucci lowered the prices on their designer clothing, their sales volume dropped. Were talking volume here, not profit. By raising the prices again, they actually sold more clothing.

When you put a high price on something, in many cases it can make people desire it more. I guarantee that if apple dropped their prices, they would probably sell less as well because it wouldn't be this trendy thing that only the "hip" or "sophisticated" people have any more.

Anyways, over 500 years of market history will tell you that supply and demand isn't fiction. Only a die hard communist chooses to ignore that.

From wiki: "Supply and demand is an economic model of price determination in a market. It concludes that in a competitive market, the unit price for a particular good will vary until it settles at a point where the quantity demanded by consumers (at current price) will equal the quantity supplied by producers (at current price), resulting in an economic equilibrium of price and quantity."

I didn't know that Gucci and Apple are die hard communists.

Re:three words, one hyphen:

[Fjandr]

First off, the free market doesn't exist.

Secondly, devices classified as health aids by the FDA exist in one of the most heavily-regulated markets on Earth.

The highest of the barriers to entry into the hearing aid market are almost assuredly in regards to assuring end-product compliance with FDA regulations.

Re:three words, one hyphen:

[AmiMoJo]

Necessary regulations probably do bump up the price a fair bit. The hearing aid has to be proven safe for human use, even if that person accidentally leaves it on when they get into the shower or receives a static shock from rubbing against something. There also has to be a hard volume limiter so that faults do not result in dangerously loud noises being emitted.

$1600 is still ridiculous, but there is also a genuine reason why hearing aids will never get to down to cheap smartphone + contract prices either.

Re:three words, one hyphen:

[Anonymous Coward]

Veblen goods?

Re:three words, one hyphen:

[Maow]

I was with you right up until this:

Healthcare would be a hell of a lot cheaper if the government stayed the hell out of it.

From a Canadian perspective, couldn't disagree more. It's as close to a unanimously held opinion up here as one could hope to find, except maybe "Go Team Canada - win gold at the Olympic Men's Hockey".

i.e. Provincial governments buy drugs in bulk, enabling discount prices (on generic drugs vs brand name), enabling citizens to receive the savings.

Or, I pay $200 / m for medical insurance for two of us, which allows us to visit doctors or specialists for "free" as much as needed (except dentists).

While I imagine the few hypochondriacs out there abuse it, no one goes without treatment, making a healthier population and lower emergency room costs as minor issues don't fester into emergencies.

Re:three words, one hyphen:

[Maow]

Oh, and to add another thing, ICBC (Insurance Corp of BC) is, what's the term, a Crown Corp (owned by government).

While no one will claim to love it, nor any insurance company, and horror stories are out there, because they're the insurer of *all* BC drivers, they tend to find it useless to go to court to determine fault - hence the no fault insurance.

Saves a fortune on lawyers. Plus, profits are routinely put into things like research (the best info on child car seats apparently came from their research), or - they pay for high crash intersections to be redesigned to reduce crashes - saves them money in the long run. They've even been known to reduce rates when there's a year with excess profits (probably coincides with an election year, but hey).

And, despite some claims, it is not more expensive than other provinces where there is only private insurers.

Re:three words, one hyphen:

[Anonymous Coward]

You appear to have some misconceptions about why we buy healthcare through employers. The problem isn't that the government helps -- it's that it doesn't.

Employers tried to save money by spending money on health plans (without paying a per-employee income tax in the money that was spent) rather than just raising the employees' salaries by a comparable amount (because that would have been considered "income" for the employees, and thus taxed, and not all of the raise in salary would have made it to the employees.) It is arguable whether the resulting lack of taxation benefits employees or employers more. Note no government involvement necessary -- in fact, the government is losing tax money due to this behavior.

To fix it, probably the easiest thing to do would be to have the government allow everyone to buy medical insurance with pre-tax dollars. That would remove the incentive for people to get insurance through their employers.

Re:three words, one hyphen:

[Anonymous Coward]

Of course, without this kind of regulation, you get the sort of situation that you have in China. Healthcare is generally pretty cheap (for instance, prescription eyeglasses for $25 rather than $150-$300+) but the quality is... dubious. It's alright and probably it'll help you, and maybe it won't, and it might make things much worse.

The high cost of medical devices is due more than anything to the huge amount of testing and QA that it has to go through to be approved. The flip side of this cost is (in theory) high reliability and safety. Of course, it doesn't always work like that.

Re:three words, one hyphen:

[Maxo-Texas]

I noticed name brand heavy cream varies from $2 to $4 as the lowest price at two different chains.

Thanks for the $10 generic tip.

Also, you can buy hearing aids with 2002 technology on hunting sites.

Part of the reason that official "hearing aids" are expensive is that they are a medical device.

The same exact device not classified as a medical device is 1/10th the price.

Re:three words, one hyphen:

[Lorien_the_first_one]

I think it's a combination of patents and "health care" industry protection from so-called free trade agreements. Noted economist Dean Baker has documented the trade and patent protection that the health care industry gets, and that the same protections are rarely ever mentioned by economists.

If "free trade" is good enough for electronics, clothing, cars and the rest of the working class, then it's good enough for the health care industry.

http://www.counterpunch.org/2009/08/04/why-don-t-we-globalize-health-care/

Re:three words, one hyphen:

[Anonymous Coward]

The way it works here in Europe is that healthcare pays for the majority of it but you have to chip in a few percent of your own cash. Best of both worlds.

Re:three words, one hyphen:

[Fjandr]

That's been my experience as well. My father had hand surgery and saved many thousands of dollars by paying in cash, by negotiating with the hospital and the surgeon.

Re:three words, one hyphen:

[Anonymous Coward]

As far as the MD trained in China... the problem with just letting foreign doctors practice here is that the quality of training varies dramatically overseas. The doctors in China who went to better universities and trained in better hospitals are probably on par with U.S. doctors. The ones who went to smaller, regional universities and trained in rural hospitals may not be qualified to practice in the U.S. A written exam wouldn't be able to distinguish, but maybe there's a middle-ground where a few U.S. institutions would be qualified to run 2-year residency programs where foreign doctors' skills are put to the test. The ones that pass get full MD privileges. The ones that don't get kicked down to medical school to start again.

A better solution would be to examine the curriculum and teaching standards in foreign institutions and then assume that graduates of those institutions are competent.

Re:three words, one hyphen:

[Man Eating Duck]

Living in a state that forbids early payment penalties helps.

That implies that there are states in which you will be penalised for paying your debt in full early? While that is probably every credit company's wet dream, it's fairly fucked up that they are allowed to do so.

Re:three words, one hyphen:

[Anonymous Coward]

Plenty of research goes on outside the USA. There is this place called Europe that is home to a number of medical research companies.

Re:three words, one hyphen:

[nukenerd]

@ Jhogl wrote :-

Incorrect.
Insurance companies barter/bargain for the lowest prices.

Then they don't make a very good job of it. My wife had a minor op done privately, without insurance. The hospital told her openly they had two prices, one for insurance jobs and one for cash customers, and the latter was considerably lower. The admin lady read out the prices from a computer screen - I am sure she was not meant to.

Insurance companies don't care much about bargaining because they do not have the time - they would need to employ lots of (expensive) skilled negotiators to do it instead of monkeys. So they just pass the cost on to the people who insure with them, and keep their cleverest employees on the sales side.

Individuals might be very careful with their money when it comes to buying boring things like bread and electricity, go a bit barmy when it comes to "interesting" things like iPhones, but go absolutely stark raving bonkers when buying insurance. They pay stupid amounts of money for "peace of mind" as the salesmen say.

Re:three words, one hyphen:

[nukenerd]

Can you cite the costs for the same device in non-for-profit countries? I dare ya.

Yes. £0 in Wales. I know someone who has just got one.

Re:three words, one hyphen:

[Anonymous Coward]

Hahahaha! This is what they tell you to do, but IME, no one ever does it. Physicians view the uninsured the way they view Medicaid patients -- as unreliable poors who usually ignore your advice and are best avoided.

Re:three words, one hyphen:

[gelfling]

Most insurance DOES NOT COVER these devices and certainly at the high end they don't. I know this from personal experience.

Re:three words, one hyphen:

[GameboyRMH]

You can market it as a "recreational sound amplifier" to skirt the regulations entirely Mr. Randroid. Seems preferable to the Somalian health care system.

Re:three words, one hyphen:

[leonardluen]

any why shouldn't normal headphones be required to meet most of that criteria?

Re:three words, one hyphen:

[c 0xFF]

I know it's not xkcd, but http://abstrusegoose.com/389">this is obligatory.

Re:three words, one hyphen:

[Anonymous Coward]

Wow, we got it all here, a totally unneeded comparison, the bad communist joke, "law of economics" (whatever that is, I'm an economist and have never heard of it) and the must-do bashing of Apple :)

So an explanation is in order!

Communists understand supply and demand, they just don't buy the whole free market thing. You should read more, might hurt at first, but you'll figure it out.
Law of economics... I'll hazard a guess that's the laws of supply and demands. Same advice as before, read and learn!
The idiotic assumption that demand equates to availability and that availability dictates the price. This goes to both posters I replied to... Don't talk bullshit about stuff you know nothing about.
Equating marketing potential with a high price. C'mon... Really?
Over 500 years of market history??? You forgot to add a 2 or even 3 in front of 500, because you got written records of financial transactions going way, way back ;)
I think American educational system is at fault of letting cretins like this leave even primary education, because this is what you learn in prim. edu. history classes.

Re:three words, one hyphen:

[Imrik]

Obviously not all of it would be, but at least some of it (probably most of it) would be better than no care at all.

Re:three words, one hyphen:

[DerekLyons]

A cheap decent mid-range laptop is a shining example of *exactly* what I'm talking about. Yes, the price has come down due to competition - because costs have been ruthlessly slashed, and quality pared away to the bare minimum.

Re:three words, one hyphen:

[Anonymous Coward]

blame the military for not training them in manner which also gains them certification. should we also make it impossible to sue them when they fuck up?

Re:three words, one hyphen:

[timeOday]

Maybe lots of people wouldn't be able to get them. Or maybe prices would drop enough that you be looking at most people being able to get them.

There is already a huge market - millions and millions of people in the world - without insurance. (For that matter there are millions of people in the US alone without insurance). So if no products have appeared to serve that market, it isn't because of insurance.

Re:three words, one hyphen:

[Anonymous Coward]

perhaps we should get rid of health insurance middlemen altogether, and do business with the clinic/hospital directly. i always wondered why the places doing the actual work didn't just insurance and chose an unnecessary, cost-inflating middleman.

Re:three words, one hyphen:

[Anonymous Coward]

as long as we can still sue the hell out of whoever fucks up and never letting them practice again, i say go for it. unless you were thinking of a plan like michelle bachmann wants for the food industry, to deregulate but also protect it from lawsuits, then hells no.

Re:three words, one hyphen:

[timeOday]

Easier to throw money around when it's someone else's money.

Sounds common-sensical. But what is the fact of the matter?

In general, Medicare does not cover routine hearing exams or hearing aids of any type. In some cases, diagnostic hearing exams are covered by Medicare Part B, but this is only when they are ordered by a doctor... You pay 100% of charges for routine hearing exams and hearing aids

These generalities about people not caring about medical expenses due to insurance do not ring true to me. Is your insurance really so good that you don't pay anything? My experience, in support a family with several kids, is that I spend thousands of dollars per year after insurance.

Re:three words, one hyphen:

[jo_ham]

I see we have someone here who doesn't know what a cite is. For shame with such a low UID.

No log in, no opinion.

Log in first, then perhaps you can discuss the relative quality of a logged in poster's reply to an AC.

Re:three words, one hyphen:

[Anonymous Coward]

That's right, the free market, like perfect spheres and frictionless surfaces, is a fantasy that doesn't exist in the real world. Makes you wonder why so many people fervently believe in it.

Re:three words, one hyphen:

[Anonymous Coward]

Insurance companies barter/bargain for the lowest prices.

... that maximize their profits and shareholder value with little to no regard as to effect on policyholders.

FTFY.

Re:three words, one hyphen:

[gmanterry]

If demand increases and supply remains unchanged, then it leads to higher equilibrium price and higher quantity

If I understand what you're saying, then if "supply and demand" is a law, the companies who artificially limit supply in order to raise prices are the equivalent of someone who breaks the law and gets off on a technicality.

The only thing you've proved is the reason why there can never be a "free market": because we have companies who will profit more by making less of something. Farmers who will burn cornfields in order to raise prices and oil companies who will start rumors of oil field explosions in order to get a bump in the spot price. And there's more profit in destroying your competition than there is in selling a great product.

If the system can be gained by artificial scarcity, then there cannot be a "free market".

The one factor you all leave out of the equation is competition. If there is no competition then the seller can scam the market. However, if someone else makes a similar product and wants to sell lots of them, he will lower the price. That's the way the market worked when I was young 50 plus years ago. Then the U. S. has anti trust laws and enforced them. That meant that Circle K and 7/11 couldn't buy up all the Mom & Pop stores and take over the entire market small stores. The government turned their backs on the banking industry and allowed Chase and Bank of America to buy up all the smaller banks. Now we have banks that are too large to fail and no competition. Capitalism served us well for two centuries but when the government started allowing larger companies to get rid of competition by buying it out the system became unbalanced. I could write a book on this but I'll stop my rant here.

Re:three words, one hyphen:

[Patch86]

Teenagers are the group with the largest disposable income (better earnings than a child, no outgoings like an adult), and are the group least likely to need a hearing aid. Old aged pensioners are the group most likely to need hearing aids, and are also the group with some of the highest relative poverty rates.

Re:three words, one hyphen:

[timq]

At this point, I am fairly certain nothing will ever make Apple blush.

Re:three words, one hyphen:

[Anonymous Coward]

oh yes... please tell me of the historical efficiencies of government!

Drink more Kool-aid.

What about barriers to entering the industry?

Re:three words, one hyphen:

[Anonymous Coward]

For the past two years I've been suffering from single-sided hearing loss so I need a CROS setup (http://en.wikipedia.org/wiki/CROS_hearing_aid), basically a microphone on the bad side and an amp/headphone unit on the good side. There are fairly inexpensive wired units available, but the ones that I have tried have crap signal to noise ratios and you end up having a wire running between them. Might be easier to make it less distracting if I had enough hair to hide it, but I don't. There are mid-priced wireless units, but they also have poor sound quality and fairly high latency. That isn't as much of an issue for me because all of the sound is coming into the only ear that works so I have no effective stereo hearing anyway, but it is noticeable. That leaves the high-end wireless CROS units, and Phonak has a combination that has the best combination of sound quality and convenience that I have tried. They cost a ton and there has got to be a big profit built into that, but they are noticeably better than anything cheaper that I have had a chance to try, so my choice is to get something that makes it as easy as possible for me to continue to live a happy and productive life despite my handicap, or to settle for something that is more affordable but that is less helpful, more fatiguing and less satisfying.

Re:three words, one hyphen:

[Anonymous Coward]

Most insurance doesn't cover hearing aids for gradual hearing loss.

Try again.

Re:three words, one hyphen:

[robbo]

A government that has the power to mandate coverage also has the power to regulate prices.

Re:three words, one hyphen:

[MentalMooMan]

Using basis points removes the ambiguity when talking about fractions of percentages.

Consider: "The interest rate, previously 5%, has been raised by 1%". Does this mean the new interest rate is 6% (5 + 1), or 5.05% (5 * 1.01)?

If you say "The interest rate, previously 5%, has been raised by 100 basis points" then the only possible interpretation is that the new interest rate is 6%.

Re:three words, one hyphen:

[Anonymous Coward]

Almost no health insurance covers hearing aids..

Re:three words, one hyphen:

[hey hey hey]

there was a regional grocery store chain where I used to live whose prices were consistently about 40% off of all major competing grocery stores in the area.

I call bullshit. Grocery stores run at about a 1 to 3 percent profit margin. Some individual items might be priced wildly differently, and a discontinued store (one getting rid of merchandise other stores can't sell) might be able to do a larger discount, but 40% off of standard goods just ain't gonna happen.

Re:three words, one hyphen:

[PopeRatzo]

In fact, if you really just need a small microphone with a small speaker that plugs into your ear, you can just get a Listen Up! sound amplifier that looks like a bluetooth headset for less than $30.

And how does that explain why an expensive hearing aid, with $25 worth of parts, is selling for $1500?

Re:three words, one hyphen:

[PopeRatzo]

Supply and Demand fails in this case because there is no equilibrium. With health care coverage, demand is inelastic. If it costs the insurance company pays for it, then if it's $20 or $20,000, I don't care. I "paid" for it when I paid my premiums, what the insurance company pays for it doesn't affect me. It's against my best interests to shop price. So changes in price will not affect demand, violating "supply and demand".

Don't insurance companies have the same incentive to look for lower prices as any other consumer? If the hearing aid is $2500 instead of $250, then it's $2250 that's lessening the insurance company's profits.

Why isn't the insurance company like any other consumer in this case? And why aren't there cheap Chinese knockoffs of the really expensive hearing aids?

Re:three words, one hyphen:

[shaitand]

No doubt but the problem with regulation surrounding the FDA is the legal protection that is afforded to entities that have jumped through FDA hoops. Get rid of FDA indemnification of FDA approved products and we will be closer to fixing those things. But it isn't like we can get rid of the FDA and regulation in healthcare either.

At the end of the day healthcare is a field where the only morally acceptable profit is nothing because anything else denies essential care to those who need it. At the same time nothing is certainly not fair to healthcare providers. Even 'at cost' is hyper inflated.

The free market is simply a poor choice for healthcare. There is no room for the overhead of giving the lawyers, researchers (who are working on CYA data at the behest of lawyers), manufacturer, distributor, insurance companies, hospital and doctors healthy cuts in the profits on literally every item. Every one of these groups makes insane profits despite having a handful of excuses for why they have to charge so much. The only ones not driving fast cars and living in million dollar homes are the consumers.

A few weeks back while making dinner I sliced a fingertip. It was off the tip where I couldn't stitch it and substantial enough that I wasn't sure if it would heal on its own. So I wrapped some gauze on it and went to the hospital. After a 5 hour wait they got me in. A medical technician invested the 5 minutes it took to put a little piece of cellulose web on the finger that helps it coagulate and fresh gauze he also invested a minute in telling a physicians assistant to write a quick script for a small amount of pain medication.

What did a grand total from all staff of under 10 minutes of attention and a couple forms of cotton fuzz cost? $1600. My co-pay on that should be $150. If $150 were the entire charge it would be far far more than is reasonable. The only ones in the entire chain who lose out on the deal are myself and to a far lesser extent my employer.

Re:three words, one hyphen:

[Anonymous Coward]

In fairness, there are things you encounter in civilian life that you don't encounter on the battle field. A combat medic specializes in trauma from weapons rather than e.g. treating heart attacks/strokes. They are also less likely to be trained to handle pediatric/elderly patients because their main responsibility is to treat soldiers/marines. There should be something similar to transfer credits to deal with this - receive credit for course equivalents/training already received while getting additional instruction to cover what the military training lacks or de-emphasizes.

Re:three words, one hyphen:

[Anonymous Coward]

Testing of new drugs is important, that said, Underwriter's Laboratory, not a governmental body, does a pretty good job evaluating consumer goods. The FDA uses visual inspection to evaluate meat rather than microbial testing which would be much more effective at detecting issues. The FDA did help us avoid thalidomide and some other problems, but how many die from the lack of treatments while they wade through the regulatory swamp?

Re:three words, one hyphen:

[Roachie]

The same reason college tuition has gone up during a massive recession- government assistance drives up that cost. Hell, my university is practically a branch of the government.

In this case, concerning the hearing aids, its Medicare.

Greed ( whatever that is ) is insufficient to drive up costs in a free market.

Re:three words, one hyphen:

[AK Marc]

Don't insurance companies have the same incentive to look for lower prices as any other consumer? If the hearing aid is $2500 instead of $250, then it's $2250 that's lessening the insurance company's profits.

Insurance is regulated. Disclaimer: I'm familiar with the laws as of 10 years ago, but not anything changed since then, so there may have been some change with Obamacare, but I didn't see anything that did

The insurance company is limited to a profit of XX% (I'll assume 10%), as a regulated entity. So if they charge premiums too high, they get penalties. So, if their revenue is $10,000,000 on 40,000 Chinese hearing aids, they can keep $1,000,000 profit, maximum. But if they pay $100,000,000 on 40,000 expensive ones, they get to keep $10,000,000 profit.

Regulation breaks supply and demand. Insurance is regulated in 50 different ways in 50 different states, and I am 100% certain that auto insurance works like that because of my dealings with State Farm in Texas, who would send me a check every year. See, they would charge more than the legal maximum, then, if claims were not excessive that year, they'd make more profit than allowed, and they'd have to refund money. With the risk pools, they justified it for auto insurance with nobody making a stink, but the same general rules applied to the other regulated insurances (the common ones, including health). But, as the system is designed to not have people directly buy their own health insurance, I did not deal with them directly on that, but I know the rules were set up similarly.

And why aren't there cheap Chinese knockoffs of the really expensive hearing aids?

There are. You just have to buy direct, as if they were sold through a US storefront, they'd be shut down by the medical industry.

http://www.aliexpress.com/wholesale?SearchText=hearing+aid&catId=0&manual=y
http://www.dinodirect.com/se-hearing%2520aid/currency-USD.html

Really? You couldn't be bothered to do a single google search to find the answer to your own question, but willing to waste our time having to read it? You are lazy and inconsiderate. Oh, and $250 is overpaying for the Chinese one, looks like $25 would get you a mid-range Chinese one, or $2000 for the same thing sold in the US by a US medical company. It's cheaper to buy it from China than to pay the US copay, so the real question is why aren't more people going that route?

Re:three words, one hyphen:

[Man On Pink Corner]

Makes you wonder why so many people fervently believe in it.

Whatever. Do you have a response to the GP's point? The market for medical devices is about as "free" from government interference as your average Soviet gulag.

Re:three words, one hyphen:

[Anonymous Coward]

the laws of supply and demand are like newton's law of gravity. Accurate for explaining a two body classical problem, but fall apart at the very big and very small scale, and becomes very hard to model as you add N bodies. supply and demand gets hard to model when other products will eat your market share, or you have a government preventing the competition from forming, or you are dealing with rationing. supply and demand also doesn't work as it regularly should in cases where personal relationships are the determining factor in price, and global market level where a monsoon in Sri Lanka can affect wheat prices in Kansas.

Try explaining this to a free market type person and their eyes glass over, and then they change the subject to how Obama is a communist or some other spiel.

Re:three words, one hyphen:

[bill_mcgonigle]

Do you know enoug people who will volunteer to give their lives to charity work as an audiologist to meet the demand? There may be a few, but most need to be paid because they have life expenses. As I understand it, the price of a hearing aid includes lifetime support, which means paying the audiologist for an average of n number of fittings/adjustments.

It's a shame there's not a model where the device costs what the device costs and then support is paid out of pocket. But 90% of people are happy to overpay for their cell phones by $1200 with contract obligations too, so it's not all that surprising.

Re:three words, one hyphen:

[Firethorn]

I believe that there are such states, and yes, it's fucked up. Used mostly by shady dealers who use such clauses to ensure they get their 21% interest no matter what, even if the person improves their credit and could get a better deal refinancing.

Re:three words, one hyphen:

[nbauman]

Why? Healthcare was freely available to the poor prior to government involvement in the industry. Doctors would even make housecalls to tenement houses.

In the days when doctors made housecalls to tenement houses, cancer drugs cost $30, not $100,000. The life expectancy at birth was about 50 years, rather than 75 years. And most of the savings in lives came not from doctors' treatments, but by government public health measures like clean water, sanitary sewage, and regulation of often-contaminated products like milk. Government intervention works. The UN eliminated smallpox.

Free markets work, no matter what you say about them. If they didn't, then computers would be ultra expensive and unavailable, while the Post Office would make money.

(1) Computers, like most industries, are a success of both the free marketplace and government support. Gordon Crovitz inadvertently demonstrated that in a Wall Street Journal editorial page column which claimed that the government wasn't responsible for the Internet. He was quickly corrected by the very people he credited with creating the Internet. And yes, they said that Al Gore helped. We should all thank Crovitz for making a fool of himself and educating the public on this issue.

(2) The U.S. Postal Service does make money. You may have missed it, but they're not longer subsidized by the government. They would show a comfortable profit, except that a conservative Congress, in an attempt to discredit the government, required the USPS to adopt accounting principles that nobody else uses. They have to treat their entire pension fund as a liability, which makes them look bad. In the free market, you pay UPS or Fedex $15 to deliver an envelope. Do you think that if you removed the competition of the USPS, UPS and Fedex would lower their prices?

(The Wall Street Journal, that bastion of free-market exceptionalism, was trying for years to develop a delivery system that would be cheaper than the USPS. They failed. The one government service the WSJ didn't want to privatize was the USPS. They'd lose half their circulation. And no, they can't substitute the Internet.)

Re:three words, one hyphen:

[nbauman]

Look at areas of medical treatment in which the government is not involved. Sadly there are very few of those, but take for example Lasik surgery. Prices for that drop every single year. Why? Because of natural market pressures. People usually pay for that out of pocket, so they naturally price- and quality shop. Lasik establishments are incented to reduce costs and improve quality. And they do.
 

Let me answer the LASIK free market fallacy.

I made my living for a few years following LASIK and competitive technologies. I spoke to designers, manufacturers and ophthalmologists, and wrote articles about it.

1. The reason LASIK got cheaper is improved technology. Refractive surgery started out as a manual procedure and became increasingly automated. The procedures got faster, and the skills got lower. They tested different lasers and found the wavelengths that worked best. Once the best procedures were established, it was easy for an ophthalmologist to buy a laser, take a course, set himself up in the LASIK business, and start cutting prices and giving introductory offers.

LASIK wasn't a free market. They had a lot of FDA regulation. The FDA did a lot of their quality control. That's why they didn't wind up like the New England Compounding Center.

2. I also followed cataract surgery. During the same period, the cost of cataract surgery dropped just as much as LASIK, for the same reasons -- better technology. Cataract surgery used to require a large incision with a hospital stay. Now it requires a small incision as an outpatient procedure. The lenses got better.

Cataract surgery is overwhelmingly done under Medicare. As cataract surgery got easier and faster, ophthalmologists were making a killing, doing simple surgery and getting paid for complex surgery. Medicare renegotiated the fees, to bring the price of cataract surgery down so that the ophthalmologists' income went back down to what it used to be. That''s why cataracts cost less. Because the government, efficient and well-managed in this case, negotiated the prices down, the way they do in other countries.

Even so, you would be crazy to shop for eye surgery based on price. You don't want the best price, you want the best doctor, who is least likely to make a mistake. You could lose your eye. The malpractice award, if you get it, won't pay enough to be worth it. You can't look up an eye doctor on Yelp. If the government doesn't establish standards and quality control, you're fucked.

Re:three words, one hyphen:

[Anonymous Coward]

Cosmetic surgery is also for-profit, and it doesn't go up like this. Unlike hearing aids, cosmetic surgery is seldom covered by insurance. And for hearing aids, the insurance is likely Medicare.

Re:three words, one hyphen:

[nbauman]

There was an article in Science about the Chinese health care system, and they had a photo of people sitting in a room getting infusions of antibiotics for colds and flu. (Antibiotics are useless for colds and flu.) As a result, they were getting epidemics of antibiotic-resistant bacteria.

China's a big place. There are some very good doctors. There are also some very bad ones.

Re:three words, one hyphen:

[Anonymous Coward]

I recently was able to get hearing aids through vocational rehabilitation. I have been severely hard of hearing since I was a preschooler(I am 56 years old). Most or all insurance companies do not cover hearing aids. Insurance companies do not cover hearing tests for hearing aids, either. The entire cost is out of pocket unless one can get assistance (like I did). If you or someone you know needs hearing aids but cannot afford them, please direct them to Vocational Rehabilitation.

Re:three words, one hyphen:

[Waccoon]

Concerning teenagers, the phone might very well be the only reason they need a paycheck.

When I was a kid, teens only worked to pay for their car or fancy clothes. Now they have phones.

Re:three words, one hyphen:

[Waccoon]

A more relevant example would be when early iPhone developers boosted their prices from $2 to $5 and saw a sales jump. A higher priced app is "worth" more than a cheap one.

Re:three words, one hyphen:

[Qzukk]

There is more than one surgeon in the world.

Well, next time I'm unconscious and bleeding out, I'll be sure to ask for one that won't charge too much.

Re:three words, one hyphen:

[_Sharp'r_]

You are exactly correct.

I could add lots more comments on this issue, but instead I'll just point readers to the same discussion from a year ago on slashdot, Is-There-a-Hearing-Aid-Price-Bubble, as there are plenty more comments there relating to government regulation and insurance 3rd party payers, etc...

I'll just toss in my own counter-example, contrasting price changes in elective surgery, like corrective vision surgery, seem to imply that the biggest part of the cost cause is the third party payers.

Re:three words, one hyphen:

[Zomalaja]

$900,000 in compliance costs for what ? Certainly not a standard hearing aid. I worked at a X-Ray device refurbisher for a dozen years, X-Ray devices are Class II. We had to furnish the FDA with a written description of our "Good Manufacturing Practices" (Copy of our ISO procedures) and submit yearly leakage reports (X-Rays that are not contained by the inner lead shielding). They sent a guy out once, he stayed and observed for two days and said thanks, good job, see ya........ Standard (Air Conduction) Hearing Aids are Class I and are nowhere nearly as regulated as anything that emits X-Rays. When you into implants, it gets complicated.

Re:three words, one hyphen:

[Anonymous Coward]

I am sorry that in your country it is illegal to put more than one sentence in a paragraph. You should move to United States where this practice is allowed.

Re:three words, one hyphen:

[Reziac]

County health care system geared toward the indigent and illegal aliens... from the sign on the wall with all the pay-in-advance prices: ANY surgery, $400. No shit. Someone asked the receptionist why it was so low, and she said that was actual cost. Price was higher if not paid in advance due to the difficulty in collecting the money.

So, yeah. Like you said.

Re:three words, one hyphen:

[LeoHat]

Yes, M.E Massengill no longer sells a product with Diethylene Glycol. For some problems, YES. The government IS a solution.

Re:three words, one hyphen:

[toddestan]

Well, compare the prices at the small grocers in the inner city to one of the big warehouse-style stores you see in the outer suburbs and you may price differences like that.

Re:three words, one hyphen:

[StuffMaster]

I was also under the impression that Chinese doctors are taught a lot of traditional Chinese medicine...which would presumably reduce their conventional medical training time.

Re:three words, one hyphen:

[shiftless]

Education? Do you think the Chinese chemists and American pharmacists didn't have enough education?

I'm not talking about the doctors. I'm talking about the public.

Do you want to send every medical consumer to medical school? That's how much knowledge they'd need to be informed purchasers in the free marketplace.

Mother fucking bullshit. If you can't make a simple decision about your health without spending four years in college then you are a dumb ass.

You'd need at least the knowledge of a nurse to make informed decisions in the health care marketplace.

Again: you're a moron.

One critical assumption of the free market is that people can make informed decisions. Most patients can't make informed decisions.

Because all they know is lies, and all everyone around them knows is lies. Give people information and teach them how to think, and yes, they are quite capable of making intelligent decisions.

Whatever problems government regulations has, without it people would (and used to) get ripped off.

Again I point out: the problem has historically been information flow....which has now been cured. Ever heard of the Internet?

Re:three words, one hyphen:

[RockDoctor]

Have you considered "rouge" or some other form of "slap" from yo' beatch's make-up bucket?

Re:three words, one hyphen:

[RockDoctor]

You poor deluded pinko communist subversive. They'll be draining your precious bodily fluids and be replacing them with hydrogen fluoride next.

Re:three words, one hyphen:

[Anonymous Coward]

The Post Office does make money, while servicing every podunk town in the US, as required by law. Certain legal documents HAVE to be served by mail, and the USPS is a vital part of infrastructure.

The problem is a conservative congress passed a bill requiring the USPS to pre-pay the pension of potential future hires, and this is what is driving them into the red. Even with the shrink in letters, the USPS has seen an increase in other postal types. They have trimmed jobs, they have gotten leaner. The one BIG problem remaining is that stupid pension bill, which is causing them to set aside money for people they may never hire, due to automation, etc.

Re:three words, one hyphen:

[yenot]

There is no "law of supply and demand". It's a fiction.

You're ignoring quality/functionality as a variable. If a product or service has a perceived (utility) value significantly higher than its dollar value, the consumer is usually prepared to pay significantly more for small improvements in quality/performance. If my employer provided medical insurance is paying the first $1500 of the cost of my hearing aid, but my perceived value of a hearing aid is $2000, I buy the high end hearing aid for $3000 and feel like I got a good deal (since I only spent $1500 out of pocket, but would be willing to spend $2000).

Re:three words, one hyphen:

[Anonymous Coward]

So would thalidomide.

Re:three words, one hyphen:

[Chuckstar]

There are A LOT of foreign medical schools. The only way to examine the curriculum is to go there and sit in on classes. And you couldn't wait until someone applied to move to the U.S. in order to do the review. Because what if they went to that school 10 years earlier? You'd have to know how good a medical school was 10 years ago. And what would you do about the fact that much of a doctor's practical medical training actually comes from internship and residency? For your proposal, the U.S. would have to have thousands of reviewers working around the world to determine the quality of medical education at med schools, internship programs and residency programs, just in case a decade later someone from one of those programs wanted to move to the U.S.

Isn't it easier to have some system to review the individual applicants?

Re:three words, one hyphen:

[nbauman]

Do you want to send every medical consumer to medical school? That's how much knowledge they'd need to be informed purchasers in the free marketplace.

Mother fucking bullshit. If you can't make a simple decision about your health without spending four years in college then you are a dumb ass.

You'd need at least the knowledge of a nurse to make informed decisions in the health care marketplace.

Again: you're a moron.

I know quite a bit more about medicine than you do. I was under the impression I was talking to somebody who was reasonably intelligent and might be worth talking to.

Once you start calling people names, that's a definite sign that you have nothing intelligent to say and aren't worth talking to.

My mistake. Sorry.

Re:three words, one hyphen:

[Anonymous Coward]

The Republicans are right - damn those burdensome regulations!!1!

Re:three words, one hyphen:

[rhalstead]

There is very little technology in a hearing aid. They may claim there is and it is miniaturized but there probably isn't 50 bucks worth of tech in there. The custom molded inserts are likely worth more than the electronics. I've worn custom molded hearing protection for years. Worn under a head set, or the old "ear muffs" you can hear your shoes contact the pavement through conduction. I have a severe high frequency hearing loss but refuse to pay that much. Insurance does not pay for hearing aids and if it did I'd still not get them at that price.

Re:three words, one hyphen:

[rhalstead]

Free market really isn't involved much where this price is concerned as there is very little competition. I think the tech is so simple and covered by patents that they charge what ever the traffic will stand. They don't even have noise canceling, or feedback protection in most.

Re:three words, one hyphen:

[Anonymous Coward]

If they didn't, then computers would be ultra expensive and unavailable, while the Post Office would make money.

Fuck off with this bullshit libertard anti-Post Office drivel. Congress forced them to pay for 75 years of pensions in 4 years. Any company would go bankrupt/lose money given that mandate.

Re:three words, one hyphen:

[shiftless]

I know quite a bit more about medicine than you do. I was under the impression I was talking to somebody who was reasonably intelligent and might be worth talking to.

You must think you're the smartest mother fucker on the planet, and everyone else is clearly a moron, if you think somebody needs to be a fucking nurse to make the simplest decisions about their own goddamn health.

I mean how the fuck did humanity even survive over the past million years without doctors with Ph.Ds to tell us how to take care of ourselves?

If you're so smart, use your mother fucking brain.

Once you start calling people names, that's a definite sign that you have nothing intelligent to say and aren't worth talking to.

No, it's a definite sign you are a stupid ass.

Re:three words, one hyphen:

[shiftless]

If you think drugs and medical devices aren't safer in the U.S. (and other developed countries with similar regulatory regimes) than in countries without FDA-like regimes, then you're just not paying attention.

At what expense?

If U.S. medical care is so wonderful and advanced and amazing, why do many Americans go overseas to "third world" countries to have major operations?

There are some problems that only government can fix. The market didn't stop GE from dumping PCBs in the Hudson river (which they'd been doing for 30 years), the government did.

No--the people did. The government didn't do shit except obey the will of the people. Do you think the government in China is stopping people from dumping PCBs in the Yangtze?

Re:three words, one hyphen:

[nbauman]

Ignorance is temporary, stupidity forever.

Re:three words, one hyphen:

[Anonymous Coward]

The law of supply and demand is fiction, the two interact in highly nonlinear and frequently perverse ways. Humans are not rational actors by any stretch of the word. Communism of course shares this insanity of believing humans are rational.

Re:three words, one hyphen:

[Anonymous Coward]

Free market in healthcare industry? This is the most regulated industry of them all, you sire are either brain dead, FUDing or trolling.

Re:three words, one hyphen:

[Chuckstar]

The government in the U.S. solved a serious problem. But it doesn't get credit for solving the problem, because it only obeyed the will of the people. (So what? Didn't it still solve a 30-year old problem?) But in China government is not doing what the people want. So somehow that means all governments are bad.

You fail Logic 101.

Conversation over, since your ideology clearly trumps any attempt to make sense. Discourse under such conditions is simply not useful. Have fun living in your logic-free echo chamber.

Re:three words, one hyphen:

[ciscoguy01]

One of the few competitive parts of the healthcare device industry, breast implants.
You go in the hospital for cancer treatment, *no one* can tell you how much it is gonna cost.
Go in the same hospital for breast implants, they can tell you to the penny.
No insurance.
If insurance were banned and you had to pay for your own healthcare you would have providers offering better service for less. With insurance involvement that just never happens. You get what we got now. Worse service for much more.

Simple

[Anonymous Coward]

Economics of scale. Semiconductor industry sells a lot of chips. Hearing aid manufacturers don't sell that many hearing aids.

Re:Simple

[SimonTheSoundMan]

As a sound engineer I find a lot of hearing aids have had major features removed. I'm always getting more and more people who have aids that have no induction loop ("T") setting. Some now come with bluetooth, good for your mobile phone but not easy to pair to a PA system, kiosk or POS.

Re:Simple

[Americano]

And, hearing aids (at least, these expensive ones) are custom-fitted to the user's ear, and custom configured to enhance the specific frequencies of hearing loss the user has.

If your Android phone had to go through all of the quality & safety checks a "medical device" goes through, and required the assistance of an audiologist to custom-shape it to your hand & ear, and then test you & configure the device so that it enhanced the specific sound frequencies that you needed... they'd cost a lot more than "$99 with a 2 year contract," too.

Re:Simple

[EdZ]

custom-fitted to the user's ear

I can order a set of custom-moulded earplugs for my headphones for £100, which includes the price of a casting of my ear canal at a ophthalmologist. An EQ is basic enough that you can buy commodity ICs to do so, and the EQ need only be performed occasionally during a checkup, and not even necessarily with the same device.

Re:Simple

[Americano]

Okay, so let's use your £100 price - that means custom fitting of the headphones on the low-price model mentioned in TFS is 10% of the price. (£100 ~ $160)

You're also trying to ignore the fact that nobody's claiming that the equalizer itself is not the expensive part - the time and expertise of the audiologist who tests YOUR hearing, and generates an auditory profile for YOUR hearing, and then enters it into the equalizer in the hearing aid is what you're paying for. How much does it cost for an hour of the specialist's time, and use of the fairly expensive testing equipment?

Re:Simple

[Anonymous Coward]

I'm failing to see how this could be more expensive than a trip to the optometrist. At worst, it maybe difficult to locate a place with the needed skills and equipment comparatively.

Re:Simple

[CrudPuppy]

A couple other points:

We deafies want to change our batteries every week or more, not every day. Have you seen the tiny size of current batteries? You must squeeze every last bit of efficiency out of the hardware possible.

The receivers (aka speakers that go in the ear) must be versatile enough to produce extremely loud sounds across the range of at least 500Hz --> 4KHz with no perceptible distortion. Distortion is the #1 enemy of deafies, and means the difference between "how are you today sir?" and "ajksdhv sdjkch asdkjhvkkf sjk?"

Oh, did I mention the receivers that must be as awesome as above, must also be able to survive something like 18,000 hours in a moist environment? (4 years, 12 hours a day)

The OS and DSP cannot even introduce milliseconds of delay while deciding what is "noise" to be filtered, what is "too loud" and should be compressed, and what was really soft but important enough to amplify even more than normal.

I don't like paying thousands of dollars for my aids, but neither do I believe they can sell for $400.

Re:Simple

[Americano]

A trip to the optometrist for an eye exam will run you about $100 for visit + exam, as I understand it, too.

So, just the custom fitting + audiologist fees account for about 20% of the cost of the device.

Now figure the materials, audio, and electrical engineering that went into the device, the software that went into the device, and all of the testing and certification it undergoes. Now add sales & marketing costs, because it *is* a competitive market, and you need to advertise and reach your target audience. Now figure manufacturing costs in. Now add in profit margins for the company & retailers.

How hard is it to understand that there are HUGE numbers of costs that go into something like this? You want a $400 hearing aid, you're going to have no profits, no money to pay all the people designing and building the systems, and no money for testing and certification. You want a sustainable business model, these will be reasonably expensive devices.

Re:Simple

[thegarbz]

I'm sure you can. As I am sure thousands other can including musicians and anyone else who is interested in high end personal audio.

Now take your 100 pound commodity earplugs, combine them with a much smaller target market, add regulatory overhead, add electronic customisation based on medical reports, and add the fact that these will likely be custom made locally and not just a bunch of mass produced transducers in a custom moulded housing, add completely different expectations of reliability and usability.

Then add the fact that these are often paid for by insurance and not at the expense of an individual.

And you're back to $1500.

Re:Simple

[Anonymous Coward]

Why should it require an audiologist to do the set-up and calibration? As others have pointed out, this can easily be done with a computer program. You know that's what the audiologist is using -anyway- to generate the EQ settings.

Not being able to buy a hearing aid without paying for services you don't necessarily want or need (or need only because you're locked in through artificial means) is rather like charging $1000 for an MS Windows install, because, hey, users are idiots so you need a Redmond drone to go and install it. Or maybe more like charging $30 for a quart of oil and requiring a mechanic to actually do the work of topping off your oil.

Re:Simple

[Anonymous Coward]

Ten years ago, you would indeed be correct.

Today? There are some truly hard-core DSP chips that work very, very fast and sip energy.

Re:Simple

[Anonymous Coward]

T-coils were common & good in the analog HAs, not so much in the digital...they just didn't work as well and now it's rare to have a T-coil in a HA. I have a new phonak HA w/fm receiver and a phonak fm transmitter(smartlinkplus). With my old old HA, I used a neck loop and the T-coil to receive the sound signal...so much better with the straight fm receiver.
My wife has bilateral cochlear implants. Talk about some fancy devices! Made by Advanced Bionics which was recently bought by phonak. I belive the total cost for her CIs with the surgery was just over $300,000.00. We paid about 10% of that.

Re:Simple

[Anonymous Coward]

Funny, I bought a device that can't introduce milliseconds of delay while both filtering ambient noise, compressing loudness, and amplifying human speech. It even goes in my ear.

Bluetooth earpieces, how are they so cheap?

Re:Simple

[evilsofa]

As a sound engineer I find a lot of hearing aids have had major features removed. I'm always getting more and more people who have aids that have no induction loop ("T") setting. Some now come with bluetooth, good for your mobile phone but not easy to pair to a PA system, kiosk or POS.

I was born severely deaf, have worn hearing aids for my entire life, and found the induction loop kind of useful but not great with the old analog phones, back when anyone still had them. Otherwise, the loop was good for hearing funny buzzing sounds in certain locations. I have never in my life encountered anything else that employed them like what you describe. Now I just take out my hearing aids and use a good $40 pair of IEMs on my iPhone when I want to make a call, and that's a thousand times better than the induction loop ever was.

As far as Bluetooth goes, in my experience it sucks. I now use a pair of good $40 IEMs when making calls or listening to music on my iPhone or watching TV, and they sound great, a thousand times better than the induction loop ever did.

Re:Simple

[Americano]

For the same reason you typically want to use other medical devices under the supervision of a trained professional - safety and ensuring a proper setup.

You write software to do it at home, it needs to be absolutely bulletproof and idiot-proof. It also needs to support a host of different consumer devices, be more secure than any other consumer device on the market.

All of that stuff will add to the cost of the device - it may make it slightly cheaper than buying the device and paying an audiologist, but it's not going to make a significant difference in the cost - maybe you'll save $50 on the price tag - eliminate audiologist fees, but spend more R&D budget building a good, secure, user-friendly interface to configure it at home.

Re:Simple

[BooMonster]

Now consider an iPhone app that uses the camera, gyroscope, and accelerometer, and the flash, to build a 3d scan of your ear.

Then consider a 3D printer that makes a custom case for each user based on the above scan, into which the standard hearing aid parts fit into.

Then consider another app that administers a comprehensive hearing test, and dumps the resulting hearing profile into the hearing aid.

Then let people know that their hearing aid will last them an entire year!!

You're back to $400.

Re:Simple

[Anonymous Coward]

Deafie here,

A couple other points:

We deafies want to change our batteries every week or more, not every day. Have you seen the tiny size of current batteries? You must squeeze every last bit of efficiency out of the hardware possible.

Absolutely correct. To last a week, HAs must draw no more than one or two milliwatts at 1.3V down to 1.1V. Conventional DSPs can't meet this; Instead HAs use custom-designed chips.

The receivers (aka speakers that go in the ear) must be versatile enough to produce extremely loud sounds across the range of at least 500Hz --> 4KHz with no perceptible distortion. Distortion is the #1 enemy of deafies, and means the difference between "how are you today sir?" and "ajksdhv sdjkch asdkjhvkkf sjk?"

To a point, though perception is not hearing. Hearing aids deliberately distort sounds, and CIs don't even try to sound natural. The brain adapts and learns to extract information from structured signals. It becomes normal.

I'd say the #1 enemy of deafies is the social expectations to communicate via hearing. Save that, hearing loss has been a solved problem for a very long time. It's something to see signers socializing normally while late deafened folks face social isolation.

The OS and DSP cannot even introduce milliseconds of delay while deciding what is "noise" to be filtered, what is "too loud" and should be compressed, and what was really soft but important enough to amplify even more than normal.

Nyquist is quite clear: they don't have a choice. The maximum latency before noticeable delay is about 20ms. Good news is if you set the lowest frequency of the filters to 100Hz, they introduce 10ms delay which is within the spec. Nothing exotic so far.

Beyond that, to achieve low powers, hearing aid ICs I've seen use a dedicated hardware FIR filter to process the sounds. The DSP code runs slower analyzing noise, feedback, voicing, and volume. It then adapts the FIR weights accordingly.

I don't like paying thousands of dollars for my aids, but neither do I believe they can sell for $400.

We'll have to disagree there.

Re:Simple

[thegarbz]

Nice idea but to address your points in order:

1. You're in a fantasy world.
2. Have you used a 3D print before? The amount of manual labour required to get it smooth enough to even consider putting inside something as delicate as an ear canal would bring your costs back up.
3. The most important part of a hearing test is a bloody expensive set of headphones and a quiet room, not the software that diagnoses the results.
4. ... a year? Given hearing aids last many years I'd rather pay for a decent set once than pay $400 per year.

Oh and you're still in medical territory so that cost of compliance can't be eliminated, and it IS significant.

Re:Simple

[SuricouRaven]

And as has been pointed out before, the equaliser setting part is not a hugely complicated operation. It could quite easily be automated. You'd still need a known-response audio device and set of headphones, but even the equipment cost wouldn't be much spread over the potentially tens of thousands of patients who could use it.

Because it's a medical device.

[josiahgould]

Regulations, testing, etc, will all drive the price of the unit up. But in the end it's because the manufacturers have figured out what the highest price an average insurance company will pay, and put it right at that point.

Re:Because it's a medical device.

[PlusFiveTroll]

This right here.

Put the word 'medical' in front of anything and you add a zero or two to its price tag.

Re:Because it's a medical device.

[Anonymous Coward]

BINGO! You are 100% CORRECT. I worked for a hospital installing equipment and such. A single PC that acted as a server that I could buy for $600 cost nearly $4,000 because it had to be certified and registered with the FDA because the information that was held on it was medical, and/or the software may do analysis of the data. Even changing out a hard drive or a memory chip had to come from the vendor at a high price. We couldn't fix our own servers because they were medical equipment.

Re:Because it's a medical device.

[jfruh]

But in the end it's because the manufacturers have figured out what the highest price an average insurance company will pay...

This actually isn't true, at least in the United States. Very few health insurance plans pay for hearing aids, and I don't believe their included in the mandated coverage under the ACA either.

Re:Because it's a medical device.

[Anonymous Coward]

No, it's because old people are bad tech shoppers. That's why a higher percentage use AOL, have standard def TVs, and avoid smart phones.

Re:Because it's a medical device.

[gnoshi]

A single PC that acted as a server that I could buy for $600 cost nearly $4,000 because it had to be certified and registered with the FDA because the information that was held on it was medical, and/or the software may do analysis of the data.

It is unfortunate that the costs are so high, but it makes complete sense. You are using the machine as a server holding and analysing medical data. Errors and failures could be very high impact. The solution? Probably to actually have fewer, larger servers: maybe even virtualisation on those systems if people need to have their own servers with more custom configurations (although I'm not sure how the FDA approval works, so maybe that wouldn't help).

Without regulations like this, some punter would change the RAM in a machine running a radiotherapy machine sometime, there would be a fault, and someone would wind up cooked. We don't need to add that to the existing problems.

Re:Because it's a medical device.

[DrFalkyn]

Regulations, testing, etc, will all drive the price of the unit up.
But in the end it's because the manufacturers have figured out what the highest price an average insurance company will pay, and put it right at that point.

Health insurance doesn't cover the cost of hearing aids.

Re:Because it's a medical device.

[GameboyRMH]

This. The supposed universal influence of supply and demand is a big load of idealism, it's very rare to see the effect on consumer goods. Usually any gains to be had in supply/demand effects are extracted in B2B transactions at the raw material to minor component level. The true arbiter of price in capitalism that's relevant to consumers is "what the market will bear."

clones?

[etash]

I remember seeing at least a couple of exactly the same articles on slashdot the past years...

http://science.slashdot.org/story/11/09/09/2346233/is-there-a-hearing-aid-price-bubble

http://ask.slashdot.org/story/10/03/13/1916203/why-are-digital-hearing-aids-so-expensive

has a slashdot staff a sensitivity towards the issue or something ?

Re:clones?

[Cryacin]

Guess nobody heard the last time.

Re:clones?

[AvitarX]

Here's another link at techdirt with a long rant. But they mention a company there too.

http://www.techdirt.com/blog/innovation/?company=embrace+hearing

Re:clones?

[K. S. Kyosuke]

Their hearing aids were so expensive that they couldn't afford new glasses to read those articles.

Re:clones?

[Githaron]

Guess nobody heard the last time.

I see what you did there.

Re:clones?

[awilden]

Wat?! I couldn't hear what you're saying!

Re:clones?

[Anubis IV]

It could just be that it's something many of us can appreciate since we know people close to us with hearing aids, and it's something that makes little sense to many of us, since we're nerds and have an idea in our minds of how much this sort of technology should cost. Or, ordered the other way, we see something that makes little sense and we're reminded of it on a frequent basis, so it's no surprise that it's been brought up again.

Re:clones?

[Anonymous Coward]

Nerd arrogance. The I-could-do-that-for-less attitude that comes from not having the slightest clue why hearing aides cost what they do. The high costs quotes include a guarantee, custom molding, fitting and tuning. All of which will be done multiple times until the thing works perfectly for no additional cost. And if you're still not happy, you get your money back. The cost of the microphone is hardly the most significant cost.

So, unable to understand or explain the high costs, these arrogant nerds all assume some hated boogeyman is to blame (insurance, doctors, lawyers, government). Whatever they hate most, must be at fault!

Re:clones?

[TheCouchPotatoFamine]

oh no, a few stories over years means they have a plot, you elephant you! Thank god for your notice!

Insurance pays.

[anubi]

If someone else is paying for it, who cares? Just about anything "covered by insurance" has skyrocketed pricewise.

Re:Insurance pays.

[green1]

Because "someone else" doesn't pay for it. Insurance ALWAYS makes a profit. so that means that you are the one paying for it through premiums. People like you who don't care because they don't get the bill directly are the reason that insurance premiums are so high. The premiums have to cover all the costs and still make a profit, the more procedures/devices/etc cost, the more your premiums cost. But because nobody objects (because they don't think they pay for it) the companies get away with it.

You pay for it, only in a round about way.

Re:Insurance pays.

[Anonymous Coward]

Exactly. People say the insurance company "negotiates" the lowest possible price, but ultimately their only competition is other insurance companies. If all insurance companies are paying the same price and charging the same premiums to cover that price, they don't care. In fact, if government regulations limit insurance company profits to XX% of the total cost, it is their benefit to for the price to increase (as long as it increases for all). So we have a customer who doesn't care because he is insulated from directly paying, we have an insurance company that doesn't (really) care because they recoup it in premiums. So who cares? The hearing aid makers?

I think the question is answered.

Re:Insurance pays.

[sjames]

That's the interesting part to me. The whole reason private insurance is supposed to be so much better than socialized medicine is that supposedly the insurance companies will apply strong downward pressure on costs using superior bargaining power driven by a profit motive.

It seems they fail miserably at this. Perhaps it's time to try a better approach.

Re:Insurance pays.

[SJHillman]

Surprisingly few insurances cover hearing aids. All of my jobs have had insurance that covers a hearing test, but they all explicitly state hearing aids are not covered.

Re:Insurance pays.

[Anonymous Coward]

The bulk of non-retired America does not have truly private insurance. They get their insurance in group packages through their employer. The bureaucracy and resistance to change of the companies that run these group packages is nearly as bad as an arm of the government.

Re:Insurance pays.

[Chuckstar]

And isn't that the whole problem with the structure of insurance? Consumers don't care about the cost because insurance picks it up anyway. "Sure, order that extra test", "don't give me generic, I want the name brand", etc. But the insurance company really passes the cost back right back to the consumers. So where's the part where someone says "that's too expensive, let's go with this other, cheaper, just-as-effective option". If the insurance company says it, then the customers complain about being screwed by a beaurocrat. But the customer really has little incentive to chose the just-as-good-but-cheaper option, because the extra cost doesn't directly affect his premium (it really gets spread out among all customers).

This is the point of the high-deductible insurance products: The high deductible means most day-to-day healthcare expenses entail expense to the consumer, so the consumer has incentive to keep these costs down. But the consumer is still insured in the case of larger expenses. But this still isn't a perfect outcome. In the perfect world, someone would develop a system of insurance that incentivizes the consumer, the doctor and the insurer to work together to find the optimum trade-offs between cost and outcome. None of the participants would have any incentive to spend any unnecessary money and none would have any incentive to fail to spend any necessary money. Hell if I know how to get to that, though.

Re:Insurance pays.

[sjames]

It is private insurance as in not a government service. Non-employer provided insurance is even worse, it's far more expensive and only wants to cover people who never get sick.

The fact that employer based insurance also can't seem to control costs just means the fail is bigger.

WHAT?

[Anonymous Coward]

WHAT?

Why would they?

[michael_rendier]

Most hearing aids are prolly paid for with health care...and as long as heathcare charges $99 for a paper packet of Tylenol, and get's $4000 a month for my meds for HIV...why would they want to make a cheaper one?

From last time...

[Anonymous Coward]

Wasn't the conclusion from last time that there are quite a few cheaper options around if you want some sort of generic device? The expensive devices are supposed to come with custom fitting to your ear and custom frequency response to match your hearing loss.

Re:From last time...

[guruevi]

But with the advances in 3d printing and a decent audio test setup you could drive this down quite a bit. Also, some hearing aids I've seen simply have the custom shape molded around an existing design.

Re:From last time...

[Anonymous Coward]

That would work right up until big phama shoved Uncle Sam's red, white, and blue dick up your ass.

Re:From last time...

[Anonymous Coward]

The costs wasn't so much the difficulty in creating a custom shaped piece of plastic, but the extra complication in each person having their own hearing aid that has to be tracked, requiring hand assembly (not for making the plastic bits, but for getting the components in it and double checking the computer's positioning of components, etc.), A lot of it is just the process of measuring and molding the person's ear, plus the price covers when the molding doesn't work, is incorrect, or otherwise needs to be redone. The previous story included someone giving a more detailed description of seeing a factory where they were made and some of the factors in creation.

So in some sense, the cost is more because of the service and not just material components. 3D printing might help, but would only shave off a small part of the price, as a lot of it is just for skilled labor.

Ripe for competition?

[cgenman]

Why hasn't anyone kickstartered a competitor?

Re:Ripe for competition?

[Anonymous Coward]

Patents.

Can you think of any other possible reason?

Re:Ripe for competition?

[Nyder]

Why hasn't anyone kickstartered a competitor?

Kickstarting, the solution to everything.

Re:Ripe for competition?

[SJHillman]

There are a number of competitors already out there. The problem is they don't come with the support of an audiologist, which is more than half the cost. The ability to keep going back for unlimited adjustments, professional cleanings, reduced repair rates, etc. It's not always worth it, but you are paying for a lot more than just the physical device.

Re:Ripe for competition?

[WebManWalking]

At less than half of those prices (real hearing aid prices quoted above), you could get a top of the line mobile device, then search the associated app store for "hearing aid". There are already plenty of apps for free, $0.99, $1.99, etc, that take input from the built-in microphone and pump it through to the ear buds.

Not the best quality, but it would also function as a music player, video player, e-mail client, Twitter client, web browser, handheld gaming device, video chat device, voice memo recorder, GPS/map, electronic book reader, telephone (if that's the kind of device you chose), scheduler, TiVo remote, sketch pad, musical instrument, Victoria's Secret catalog, virtual pet simulator, news aggregator/reader, alarm clock, phone book, calculator, units conversion tool, dictation device, data organizer, note pad and outlet for paid entertainment content.

Except that apps sell for so damn little these days... It would be hard to get rich, even with a kickstart. It would probably be better to sell an add-on external microphone / app combo to turn it into a decent hearing aid. Early turn-by-turn navigation systems were external hardware / app combos too.

Re:Ripe for competition?

[Anonymous Coward]

becuase you can't compete when the government is the buyer and the seller.
this is what normal people mean by medicaide fraud.
so no, fuck you, i don'think i should pay for your fraudulent shit. If you want it, pay for it yourself.
there is a reason men go deaf in old age.
yonger married men just fake it

Re:Ripe for competition?

[Anonymous Coward]

They don't NEED an audiologist. I can tell you when I can hear well enough, thank you. I don't need to pay someone $2000 to tell me that. Give me a unit I can crank up and equalize myself. Volume limit it to prevent physical damage to my ears. Maybe I will have to pay someone to make an ear mold. $100 an ear for molds. $50 an aid. It it quits I will throw it away. I can buy a HELL of a lot of $50 aids to replace a single $2000 professionally fitted aid and know what? I'm pretty sure it would do the job just fine.

Re:Ripe for competition?

[ignavus]

http://en.wikipedia.org/wiki/Barriers_to_entry

quote: "Markets with high entry barriers have few players and thus high profit margins."

Hmmm. Sounds like the hearing aid market.

Re:Ripe for competition?

[Anonymous Coward]

Just guess how long it would be for such an endeavor to be sued into oblivion for patent infringement... :-(

Re:Ripe for competition?

[SuricouRaven]

Old-school style. Before electronics got small enough to fit in-ear, a standard 'hearing aid' was a belt-worn microphone and amplifier box with a headphone socket. Primitive technology by today's standards, but it was better than nothing.

Re:Ripe for competition?

[Anonymous Coward]

Human empathy, the solution to everything.

Re:Ripe for competition?

[SJHillman]

There's a big difference in usability between a simple noise amplifier and a properly tuned hearing aid. Something that just amplifies any noise is almost useless as a hearing aid. And as I said, there;s already plenty of hearing aids in the sub-$1000 market without an audiologist. Furthermore, ear molds are on the way out. My last pair has a different setup that doesn't use earmolds - it's a lot more comfortable as it allows airflow to the ear while wearing them.

Re:Ripe for competition?

[Anonymous Coward]

So you recommend kickstarting over Viagra then? Sounds like a plan!

What's with the pisspoor English?

[AbRASiON]

"Why Can't Industry Design an Affordable Hearing Aid?"

What industry? The tech industry, the medical industry? The hearing aid specific industry? This isn't the first time I've seen industry used in this manner, we can definitely assume whch industry in most cases but it doesn't mean it shouldn't be specified. This isn't correct use here and it sounds stupid.

I only whine because I suspect this isn't an accident but another one of those poor uses which people actually think is correct and it gets perpetuated out there, like this incredibly ridiculous and weird one.
https://www.google.com.au/search?q=anymore%20nowadays&hl=en&meta=

Re:What's with the pisspoor English?

[Anonymous Coward]

And have you spotted the double "is" that seems to be on the rise? The problem is, is people don't know the difference between grammar and spelling.

Ridiculous.

Re:What's with the pisspoor English?

[Anonymous Coward]

,,,and here I thought you were going to bring up the old "can't vs won't" discussions that obviously apply here.

Like others here have pointed out it is too similar to the "reasons" less then a penny's worth of chemicals is retail priced thousands of times more then the production costs when assembled for a prescription... Exact copies of the same medicines cost much less in many countries, especially where the US prices are greater then a month or even a year's salary there.

Re:What's with the pisspoor English?

[Sperbels]

I don't understand. Are you saying this is bad grammar and that adding an adjective to industry will make it correct?

Re:What's with the pisspoor English?

[AbRASiON]

Yes it very much is bad grammar, the fact it's moderated down shows just how poorly educated people are nowadays.

But they can

[garyoa1]

They can, just don't want to. Just like tablets, phones etc. could be a lot cheaper, they are selling now so why cut price?

Government Money

[Anonymous Coward]

When you have third-party payer (especially if it is the government) prices go up unchecked. Audiologists make bank and I assume the people making the things make bank. Furthermore it is high-value to the consumer and so the producer is just taking a bite of the "surplus".

Re:Government Money

[benjfowler]

... unless you have single-payer, in which case you get the situation in the UK, where the NHS has 90%+ of the health market, and the greedy morally bankrupt cunts in the pharmaceutical and medical device industries seethe with rage, because they have NICE testing their quack medicine and devices for efficacy, and beating them down on price with government purchasing power.

America is screwed, because they have the complete inability to rein in the parasitic oligarchs feeding on the blood of the people.

This is why the righties hate government -- the dirty secret is that rather than encouraging rent-seeking parasites, strong and effective government drives them out of business.

Try looking at this here . . .

[PolygamousRanchKid]

http://ask.slashdot.org/story/12/06/13/1828232/ask-slashdot-why-are-hearing-aids-so-expensive

Re:Try looking at this here . . .

[PolygamousRanchKid]

Or here . . . http://science.slashdot.org/story/11/09/09/2346233/is-there-a-hearing-aid-price-bubble . . .

This question seems to have been discussed on Slashdot even before its existence . . .

Re:Try looking at this here . . .

[SeaFox]

This question seems to have been discussed on Slashdot even before its existence . . .

Maybe nobody's listening to the responses given. ... ... ... ... I'll show myself out.

please, won't someone think of the audiologists?

[Anonymous Coward]

Audiologists deserve to drive a Porsche too.

Same with eyeglasses

[Anonymous Coward]

It's only recently that the price of eyeglasses has come down. Quite interesting how many different retail chains selling eyeglasses are actually owned by a single company. Obviously, none of those stores really compete with each other.

Not necessarily

[Anonymous Coward]

I was just wondering about this price issue last week. I do a lot of competitive pistol shooting, so hearing protection is mandatory. The most common setup is earmuffs with amplifiers built in (so you can talk to people but still be safe because they don't amplify to dangerous levels). The ultimate setup is in-ear protection, just like a hearing aid (less hot and bulky, just more pleasant to wear, opens up other hat options besides a ballcap). But they're (http://www.earinc.com/) several thousand dollars so only the pros use them. This is not medical grade equipment, and sold as something like an "assisted listening device" so it doesn't fall under those regulations.

Miniaturization doesn't cost *that* much. I can't figure out why these are so expensive, other than they're probably bought from hearing aid manufacturers who fix the prices. I hope someone else starts manufacturing the key components soon.

Re:Not necessarily

[SJHillman]

You're paying for the audiologist too and the ability to keep going back to have them adjusted, cleaned, etc at no extra charge as well as someone to advise you. I also get manufacturer repairs done at a reduced rate (about 60% of what I would pay otherwise) through the audiologist. If you buy hearing aids from the manufacturer, they tend to be about 1/4 to 1/3 the price. Is it worth it? To some people, yes. But for most people - especially the younger generations - not as much.

Source: I've had hearing aids for 19 years

Re:Not necessarily

[Americano]

Miniaturization + selling into a fairly limited-size market CAN cost that much.

R&D costs to design the device are fairly fixed - whether or not you build 1 device, or a million devices, you still need to figure out how to fit the features you want into a unit of the appropriate size.

ASHA reports that an estimated 31.5 million people in the US have hearing loss of any kind. Of that, approximately 12.5 million people own hearing aids, and 11.1 million wear them regularly.

Compare that with the numbers of smart phones in circulation, then factor in that these are medical devices and thus require significantly stricter quality & safety controls and testing, and you might get a sense of why the per-unit share of R&D costs would be significantly higher in hearing aids than in smartphones.

Same applies for in-ear shooting protection: how many thousands or millions of these units do you think they sell each year, versus the size of the smartphone market? "in-ear hearing protection for sport shooting" is a pretty specific market niche. It's pretty regular for niche products to cost more - I'd be surprised if the people making the multi-thousand dollar sport shooting protection systems make and sell more than a few tens of thousands of them in a year.

Re:Not necessarily

[reub2000]

In-ear protection? You mean earplugs? I know etymotic research makes earplugs with a small channel to let in some noise. They don't cost thousands of dollars.

Re:Not necessarily

[Anonymous Coward]

Manufacturing scale also plays a big role - R&D costs have to be amortized over much smaller production runs for these than most consumer electronics.

You're paying $2k for a hearing aid. Bwahahaha

[Anonymous Coward]

http://dx.com/s/hearing+aid

Shooters' earmuffs

[Spy Handler]

nowadays hearing protectors for gun shooters have electronics built in. The earpieces go over the ears and damps out sound, as they've always done. However now there's microphones that pick up sound from the outside, and pipes them into speakers inside the earpiece. If the sound level outside exceed a threshold (such as a gun going off), it doesn't get piped into the speakers.

There's a volume knob, so if you crank that up you can hear much fainter sounds than your normal hearing. So you can use it like a hearing aid, sort of.

You can buy decent ones for $50 - $100.

But if government subsidies and medicare got involved, they'd probably cost $2000 also.

Re:Shooters' earmuffs

[Anonymous Coward]

The companies admit they can make them for $100 - if they are as big as the hearing protectors you mentioned.

They claim the reason it is thousands is to let it be small and hidden inside the ear.

Re:Shooters' earmuffs

[DarthBling]

If you want electronic ear plugs that do the same thing as Shooters' earmuff, be prepared to spend a bit more money than $50 to $100. Still, to get a pair of custom molded ear plugs made, it'll only will cost you between $100 to $200, and that's just for simple ear plugs. You add in the electronics and the price will go up a bit (around $50 to $500 depending on what you're getting). Hearing aids aren't much different than these "off-the-shelf" ear plugs, they're just a bit more sophisticated since they can be tuned by a audiologist to address each individual person's needs.

I had a set of custom ear plugs made a couple years ago at a motorcycle shoe and each pair was $55. Quite the bargain. Just recently, I had another set of custom ear plugs made that come with Noise Brakers and those set me back $120 or so directly from manufacturer (they're local to me, so I just stopped by their building).

Do I think hearing aids actually cost $2000 a pair? Absolutely not. So why are they so expensive then? I believe it's due to a serious lack of competition. Most people who get hearing aids are probably getting them through their insurance company or the VA, so costs are a minimal concern to them as they only have to pay their co-pay or deductible. But if you want to buy them direct yourself, the prices are outrageous and most people will just forgo them and suffer in silence. On a whim about a month ago, I went to a Sonus Hearing store and asked how much they charge for earplugs and they wanted $150 just for the impressions! Plus, I would still have to pay whatever the cost was to have the actual earplugs made. Who do they charge so much? Because they can.

Re:Shooters' earmuffs

[linear a]

And you look like you should be armed. You don't need to listen then, people need to listen to *you*.

Re:Shooters' earmuffs

[Anonymous Coward]

But if you want to buy them direct yourself, the prices are outrageous and most people will just forgo them and suffer in silence.

Nicely done.

It isn't just about insurance companies

[Ronin Developer]

Today's digital hearing aids are actually very sophisticated devices. People with hearing loss don't need all frequencies (and noise) amplified. Typically, their loss is toward specifics frequencies. The new hearing aids are programable and can enhance the specific frequencies to compensate for the user's hearing losses.

   

Re:It isn't just about insurance companies

[Anonymous Coward]

that isn't sophisiticated in the least. It's called an equalizer and it's extraodinarily easy to implement.

they know what the market will bear and are charging every cent of it.

there's clearly no competition, the question everyone should be asking is, why not ?

Re:It isn't just about insurance companies

[M. Baranczak]

OK, so it's not just an amplifier, it also has a programmable equalizer. I still don't see how that adds up to $2000.

Re:It isn't just about insurance companies

[sjames]

The guy that designed the things doesn't buy that line.

Re:It isn't just about insurance companies

[Anonymous Coward]

> The new hearing aids are programmable and can enhance the specific frequencies to compensate for the user's hearing losses.

My android phone has an equalizer and does all that. You can buy a brand new TracPhone with that level of processing power right now in WalMart for about $80.

Re:It isn't just about insurance companies

[Anonymous Coward]

You can buy a brand new TracPhone with that level of processing power right now in WalMart for about $80.

Which I'm sure it's the size of two M&Ms, same as the $2000 per ear Siemens hearing aid described in the OP.

Re:It isn't just about insurance companies

[thegarbz]

that isn't sophisiticated in the least. It's called an equalizer and it's extraodinarily easy to implement.

Oh it is. The end result will significantly worsen the rate of hearing loss for the wearer. Or did you think that a hearing aid just takes a deaf individual and shouts in their ear even louder.

No hearing aids do all sorts of weird and wonderful things including frequency shifting and dynamic range compression, often with very specific target frequencies. It's much more than your basic EQ.

Re:It isn't just about insurance companies

[Anonymous Coward]

Bandpass filters are old stuff. Equalizers are old stuff. There is no good reason for an aid to cost what it does. It probably has $20 of electronics in it. A cheap MP3 player has an equalizer, which is all the aid has. You can get a player for well under $100, and it has a display, lots of flash, knobs and buttons, other expensive stuff.

Re:It isn't just about insurance companies

[TheCouchPotatoFamine]

yeah seriously "sophisticated EQ" because I know nothing about electronics yeehaw!

bluetooth

[sentientbeing]

"it isn't clear why it costs thousands of dollars while other electronic equipment like cellphones, computers and televisions have gotten cheaper."

So buy Bluetooth headset instead. Problem solved. You're welcome

Re:bluetooth

[geekoid]

Thanks, but we want a solution that actual solves the problem.

Here's an idea - bluetooth

[Anonymous Coward]

Everyone has a bluetooth earpiece. So, two of those and an electronic box that goes in the pocket. It sounds like it could be built with an Arduino or something similar. There are enough deaf electronics experts to get this going as an open source project.

Twenty years ago, a bluetooth would have looked really weird. Now, everyone wears them. That makes them less conspicuous than an actual hearing aid.

Re:Here's an idea - bluetooth

[Anonymous Coward]

Everyone has a bluetooth earpiece. So, two of those and an electronic box that goes in the pocket. It sounds like it could be built with an Arduino or something similar. There are enough deaf electronics experts to get this going as an open source project.

Twenty years ago, a bluetooth would have looked really weird. Now, everyone wears them. That makes them less conspicuous than an actual hearing aid.

The thing is, bluetooth headsets don't go loud enough for me to hear.

That's the problem with hearing loss: if you could hear, you wouldn't need the device.

Hunting hack

[Tablizer]

I hear* one can take hunting hearing aids and with a few modifications use them for regular hearing aids. These devices are intended to make it easier to hear and locate far-off game. I don't know how easy it is to adjust them for specific frequencies, though, if you have range-specific loss.

* No pun intended

Check prices in Europe

[rrohbeck]

500 to 2,000 Euro.

Because people are willing to pay.

[Anonymous Coward]

If you were rendered deaf today, but were given the chance to hear, would you turn it down because it cost $2000 instead of $200? People value their hearing really highly, which should not be a surprise. Comments about insurance miss the point. If insurance ceased to exist, the only significant effect would be that some people would just stop being able to afford hearing aids. Anyone who can afford $2000 for anything will pay $2000 for a hearing aid.

As for competition lowering prices - no one actually wants to do that. Very few people or companies actually gets into a market with the sole goal of driving down prices; that's a strategy for some, but only if they think they can get more total profit in the long run. If most everyone who would use a hearing aid is already buying one at $2000, no company has incentive to lower that price, be they an established player or an upstart competitor.

Rational self interest.

[Anonymous Coward]

That's why.

Good article

[kilodelta]

As someone whose hearing in the left is about 65dB down I know I'm going to have to do something eventually. But I kept getting put off by the cost. Thanks to this article I think I've found one I like for about $300. Not bad.

Again?

[Anonymous Coward]

Slow news day..?

One word...

[anlprblite]

Medicare. This is what happens when other people pay the bills. And people want more of this? It is like any other government service. You charge as much as possible for the service as long as you stay within the government guidelines for price, you get to keep upping the price. If you actually let the market decide and not allowed a continuous government bailout of our healthcare system, read, medicare, then prices would get to a sane level. The greater good served by more people having affordable care would offset the number of those who could not afford it. I don't see why people don't understand how contracts and government programs work. We have a few examples, but hey, bread and circus, right?

Re:One word...

[benjfowler]

Terrorists hate countries with strong governments, and they hate countries with no government (because the Americans can fry them with Hellfire.) They go for countries with _weak_ governments -- enough to keep the Americans out, not enough to send them to hell.

Capitalists love weak governments for the same reason: strong enough to protect property rights, weak enough that they can run trusts, set up monopolies and suck the blood of the people like the bloated tick parasites they they are. Crony capitalism, as practiced in places like the US and China isn't real capitalism: it's feudalism. Real capitalism, and healthy functioning markets depends on a strong state with a strong hand to step in to level the playing field and stamp out abuses.

This is what 'small' (read: weak) government gets you: a dystopian crony capitalist hell, where entrenched monopolistic parasites are free to corrupt the political system and distort the markets.

Re:One word...

[nbauman]

Medicare.

Medicare doesn't cover hearing aids.

Medicare does cover cataract surgery, and the price of cataract surgery has dropped dramatically over the past 30 years.

Re:One word...

[number11]

Medicare. This is what happens when other people pay the bills. And people want more of this? It is like any other government service. You charge as much as possible for the service as long as you stay within the government guidelines for price, you get to keep upping the price. If you actually let the market decide and not allowed a continuous government bailout of our healthcare system, read, medicare, then prices would get to a sane level. The greater good served by more people having affordable care would offset the number of those who could not afford it. I don't see why people don't understand how contracts and government programs work. We have a few examples, but hey, bread and circus, right?

WTF does Medicare have to do with hearing aids? I'll tell you what Medicare has to do with hearing aids:

Medicare doesn't cover hearing aids or exams for fitting hearing aids.

That's a quote from "Medicare & You 2013: the official U.S. government Medicare handbook".

Me, I don't see why some people don't understand how business works when it can get away with it. But that's just me.

Re:One word...

[dadioflex]

Or kill cripples. Once those darn cripples are taken out of the system, us normals can enjoy our cheap premiums. Oh, and anyone with cancer. Kill the cripples and anyone with cancer. And kids - you any idea how much kids cost in medical insurance? Best drown them at birth. Also child-birth charges. We need to wriggle out of those. Let's remove any leveling mechanism from public health insurance because it's obviously, and clearly a scam. Once only healthy people aged 20-40 need health insurance, then we can finally get a realistic premium.

For-profit system

[bowens]

My significant other is a speech pathologist and she went to school with a bunch of audiologists. While they were in school the audiology students were able to attend several lavish conferences, fully paid for (travel and hotel). Who paid for them? The hearing aid companies. They were given tickets to hockey games (yes this is Canada) and even jewelry. She asked her audiologist classmates if they felt it was a conflict of interest that they were accepting these gifts from the hearing aid companies. Most shrugged it off and said it wouldn't affect their opinions of the products. But how could it not? A few products then get recommended to patients, the companies can jack up the prices, and of course the audiologist will sell you the most expensive one because that is the one the companies are pushing as the best in the market. Review your hearing aid options online and take the audiologists word on a product with a grain of salt.

Re:For-profit system

[GameboyRMH]

Well there's your answer everyone. Mystery solved.

You can have 2: cheap, realtime, or resolution.

[Miamicanes]

Hearing aids are unique among consumer electronic items, because they have almost zero tolerance for latency. If the media stream coming from your entertainment device is delayed by 12ms, you'll never notice the difference. If the sound coming out of your hearing aids is delayed by 12ms, your ability to locate items by sound and react to them is going to be completely borked. At best, you'll be stressed out and irritated. At worst, you'll feel disoriented and confused.

The problem is, all of the cheap ways to do digital signal processing add intolerable amounts of latency, so hearing aids are stuck with hybrid analog+digital designs that try to keep their filtering problems in the domian where they can be resolved the fastest. With digital designs, you can get away with sloppy designs that have corners cut and mostly get away with it if premature failure is OK as an option. With analog designs, every penny you shave off is going to have consequences, and those consequences add up quickly. Mixed-signal designs are the worst of both worlds -- you have to use premium-quality components and be aware of analog signal behavior every step of the way, then turn around and try to fix the noise and artifacts introduced by the digital part as well.

Yes, a hearing aid that simply amplifies sound through some cheap analog means, maybe with simple filtering, would be very cheap to make. However, for most users, that kind of hearing aid would be about as useful as a pair of drugstore reading glasses for somebody who has astigmatism. For profound hearing loss, making speech recognizable is about as hard as trying to fix botched laser surgery that's left somebody with higher-order optical aberrations that simply can't be fixed by a simple symmetric lens.

God/Nature/the Univrese has a cruel sense of humor, and here's an example that will make sense to people who had high-end car stereos at some point in the past. Remember what happened when you ran your stereo's line-level signal through a low-pass filter to separate out the bass channel? It flipped the phase, and made it lag. At the time, you probably dreamed of the day when you could use a DSP to implement an infinite-slope crossover that fixed both problems. Then, years later, you learned the cruel truth: in order to implement such a filter, you had to wait until you had a few thousand samples to analyze and work on... and the time you had to wait until you had a big enough window of samples to analyze ended up being almost exactly the same amount of time that the analog low-pass filter delayed the bass. The digital breakthrough is that if you don't have to do that analysis in realtime, and you have enough storage space to analyze the music offline, then re-sync everything up and store all the individual tracks separately, you can achieve the flawless perfection you always sought as a teenager with laggy bass. It's now cheap and easy to do, because you can take a whole CD, rip it to raw PCM, analyze it with your PC into separate 16-bit audio tracks for every single speaker element in your car, tweak their phase relationships to your heart's content, then write it all to a microSD card & have room to do the exact same thing to a few dozen more CDs.

The problem is, hearing aids don't have that luxury. They're one of the hardest-core realtime applications out there. You can't sample the sound, recursively process it, then go back and remix it at your leisure until it's *exactly* right, then play it over and over again thereafter. You have roughly half of a millisecond to do what you're going to do and send it to the transducer in the user's ear canal.

Of course, there's a big gray area of users whose hearing problems wouldn't be solved by cheap analog hearing aids, but like someone who's got a diopter of astigmatism and moderate far-sightedness, a pair of $12 reading glasses from the rack at the drug store would probably be better than nothing at all. But make no mistake... even if you could embrace the hacker/maker ethic, buy your own best-of-breed he

Re:You can have 2: cheap, realtime, or resolution.

[Anonymous Coward]

I suspect that an ADC, CPLD, and a DAC ($10.00 total in quantity, possibly under $1.00 depending on options) could do most of what you're looking for, and still fit into something the size of a pencil eraser these days. Have some configurable FIR/IIR filters (realtime), and use some more advanced logic to switch between or adjust them realtime to adapt to different volume and noise levels. If you were clever, you could probably drop the DAC and drive a switching amplifier output directly from the logic.

Add a switching power supply, small battery, and you're done. Programming could be done with a modulated IR photodiode.

Re:You can have 2: cheap, realtime, or resolution.

[SpinyNorman]

OK, so you need to hire a decent professional engineer to design your hearing aid. This isn't a DIY project. We get it.

That one-off expense is no excuse for the cost.

Re:You can have 2: cheap, realtime, or resolution.

[benjfowler]

Well, if you can't dazzle 'em with brilliance, baffle 'em with bullshit.

You're overlooking one thing: the performance of all that hardware is increasing at least as fast as Moore's Law. The knowledge on how to build reliable, robust real-time systems is improving at a lesser rate, but is otherwise progressing steadily. The hardware is shrinking all the time.

OTOH, requirement for hearing augmentation remains constant.

Surely, the gains have to show up somewhere. Obviously it's not in the price of the product these people of dubious morals are selling.

Re:You can have 2: cheap, realtime, or resolution.

[gnasher719]

Hearing aids are unique among consumer electronic items, because they have almost zero tolerance for latency. If the media stream coming from your entertainment device is delayed by 12ms, you'll never notice the difference. If the sound coming out of your hearing aids is delayed by 12ms, your ability to locate items by sound and react to them is going to be completely borked. At best, you'll be stressed out and irritated. At worst, you'll feel disoriented and confused.

Is that so? I can understand that different latencies on the left and right ear would cause problems, because the brain uses tiny differences in the arrival of sound on the left and right ear to determine direction. But if you manage to keep the latency absolutely identical, I would think it should cause no problems.

My left and right ear should receive signals at most maybe 0.6ms apart, so the difference in latency should be a lot less than that. Probably below 0.1ms or less.

Re:You can have 2: cheap, realtime, or resolution.

[jimmyswimmy]

Just to hit on the basic point parent was discussing - that digital filtering is undesirably slow yet perhaps the best way to go...

I am not a hearing aid designer, but I've built lots of sensors. It would not be difficult to build an all-analog circuit with an ability to tune the gain on specific frequency bands via a digital potentiometer. When you have a lot of different, narrow bands it becomes challenging to fit all that in a tiny package. If it were just that, you could have the electronics for ~$50. Of course there's much more to a hearing aid than a few transducers and gain stages though.

Re:You can have 2: cheap, realtime, or resolution.

[Pigeon451]

Sure it is. You know how expensive a professional engineer costs? How about several engineers and other employees? These companies don't sell millions of hearing aids a year, it's a niche market, with lots of products to choose from.

It's a good thing insurance covers the cost, unless you live in the USA -- then you're screwed and can only afford 10 year old tech...

Re:You can have 2: cheap, realtime, or resolution.

[Lucidus]

But they do sell millions. How many old people live in Europe, Japan, and the USA?

Re:You can have 2: cheap, realtime, or resolution.

[Anonymous Coward]

But if you manage to keep the latency absolutely identical, I would think it should cause no problems.

Except for the tiny fact that most people only wear one hearing aid as hearing loss is more often than not asymmetric.

Re:You can have 2: cheap, realtime, or resolution.

[Anonymous Coward]

Licklider solved this problem in 1944. Clip at the maximum comfortable loudness level, and turn up the gain until soft sounds are intelligible. Basically, as long as you don't throw out the timing of the high-low signal transitions, you can get by with one bit of information. The relevant data for intelligible speech is all in the timing and frequency of the zero crossings, and has almost nothing to do with any kind of gain.

http://books.google.com/books/about/Effects_of_Amplitude_Distortion_Upon_the.html?id=2mbeGwAACAAJ

What you don't get is direct amplitude sensitivity, but that's actually carried in subtle ways by the swamping of the small scale signals by the larger scale signals. It works quite well in practice..

Re:You can have 2: cheap, realtime, or resolution.

[DerekLyons]

No, you don't get it. There's a hell of a lot more to getting a product on the shelves that just designing it, and not all of it is a modest one-off expense.

Re:You can have 2: cheap, realtime, or resolution.

[martin-boundary]

No, you don't get it. The argument is that the _design_ is too complex for anyone other than a highly trained engineer. Ok, have an engineer do the design, _once_. Then it's done.

Put the specs on the internet, let anyone build their own for free if they like. All that nonsense about marketing, shelf space, and blah blah blah is unnecessary. Hearing aids will still get built. And they'll be much cheaper than they currently are.

Re:You can have 2: cheap, realtime, or resolution.

[DerekLyons]

Only a true moron would suffer under the delusion that a complex design with unique parts could be built from "specs on the internet". Try reading the last paragraph of the original comment jackass.

Re:You can have 2: cheap, realtime, or resolution.

[Anonymous Coward]

Millions - but not hundreds of millions.

Think economy of scale two orders of magnitude lower. It matters. And you can't run ads nor apps on your hearing aid.

Re:You can have 2: cheap, realtime, or resolution.

[erik.martino]

An option would be to collect hearing aids from deceased people that obviously don't need them anymore. Adjustment is obviously a problem. A solution could be to have a wide selection of used hearing aids and let people choose which one they prefer. It would probably require a non profit organisation to collect the hearing aids. But used hearing aids are a valuable resource that should be put to good use.

Re:You can have 2: cheap, realtime, or resolution.

[hankwang]

"all of the cheap ways to do digital signal processing add intolerable amounts of latency, so hearing aids are stuck with hybrid analog+digital designs"

I don't see what kind of analog filter circuits would would be so difficult to simulate digitally with more than 1 sample of latency. An analog filter is essentially a network of components that subtract, add, multiply, and accumulate voltages. That's trivial to do with a low end dsp which acts on a digital stream and has a couple of bytes storage.

Re:You can have 2: cheap, realtime, or resolution.

[martin-boundary]

The jackass is you. All I'm seeing is "it's always been done like this, therefore that's the only way to do it, now with pseudo-economic mumbo jumbo".

Nice in theory, except the world is 7 billion people and the USA is a puny 300 million. There are literally more old people with hearing problems just in China than there are people alive in the US. Put designs up on the internet, and there will be a flood of cheap products.

Re:You can have 2: cheap, realtime, or resolution.

[Anonymous Coward]

While my grade school daughter gets new ones every 4 years, hearing aids last old people 5-10+ years. Now consider how many companies make them. It's not like they share tech with each other, each company is essentially inventing the wheel at the same time. R&D is expensive, tolerances are certainly not what they are for disposable cell phones (how long do people usually keep that shiney new iPhone? 1 year? 2? That's disposable). What is the defective rate of cellphones (phones that must be replaced under warranty)? These numbers would not be acceptable in the hearingaid industry.
 
As much as I'm like to blame the US healthcare boogyman (usually a safe bet), 'aids are just a different story. My daughter knows to take very good care of hers because they would cost more to replace than the car I drive to work.

Re:You can have 2: cheap, realtime, or resolution.

[Anonymous Coward]

That's only true if you're designing a hearing aid to amplify sine waves with predictable waveforms. Real-world sound is a bit messier, and Fourrier needs quite a bit more than one sample to analyze.

Media playback is a different animal, because you already know what's in the pipeline, and can peek ahead to see what's coming. Ditto, for broadcast/streamed media. If you delay it by a half-second to buffer enough for a look-ahead buffer, the user might be annoyed by having to wait for a second after changing channels/streams, but won't notice thereafter unless he has another device playing the same content with different delay within hearing distance (ie, the unfortunate norm with modern hdtv, because nobody thought of requiring additional buffers and some kind of "household heartbeat" to keep everything in the house equally-delayed and sync'ed up... hell, tv and cable/sat box makers can barely keep audio and video for a single stream THEY'RE PLAYING in perfect sync).

The truth is, modern best-of-breed hearing aids are BOTH legitimately expensive to make AND excessively marked-up & overpriced. The nice thing is, for tech-savvy consumers, problem #2 will largely solve itself as increasingly-sophisticated hearing aids that can be programmed by advanced & motivated consumers become easier and easier to buy online (or buy on a day trip to down to Tijuana to get the earmold fitted, then wear it home; the USB programmer gets mailed from China, and the software just gets downloaded).

Re:You can have 2: cheap, realtime, or resolution.

[Anonymous Coward]

That would be true, except that there's this wonderful class of algorithms called infinite impulse response (iir) filters - which have exactly the same shape as their analog counterparts. As with analog, you get a certain amount of phase distortion, but with a delay of only a few samples. Pipeline this with a digital allpass filter to compensate for the phase change and you're still only dealing with a few tens of samples - and they are insanely cheap, computationally, to implement. If you're smart, you calculate the filter taps on a PC (the heavy lifting part) and download them to the hearing aid to run (the easy part). IIR filters are asymmetrical computationally, allowing you to exploit the effective difference between the power of a PC and the power of the DSP in a hearing aid.

If you're trying for better performance, you're in this situation... at 22k samples/sec, a 256 sample frame would be equivalent to about 12msec. You need to do a fast Fourier transform, a matrix multiply and an inverse FFT. Unless you are a fool, you dun this pipelined, for about 24 msec latency. The human perceptual limit is about 50msec, so you're OK. This is well inside cheap DSP territory. For your computations, you are getting a 256 point convolution - which is a very, very powerful operation. Again, the difficult part is designing a convolution kernel appropriate to the task. The advantage, again, is that you do that part on a PC, and upload the 256 byte filter kernel to the device later. Again, you can trivially exploit the power of modern PCs to do the 'heavy lifting' and let the simpler hardware in the device do the relatively easy part of the job.

FFT is O(N log N) operations. For 256 byte FFT, this is about 620 operations. The inverse is about the same - so we're talking 1240 ops, roughly. Add the multiply (which, because we're in the frequency domain, is actually a convolution) and you get to about 1500 operations. Assume you're fairly smart and use hardware sample buffers for input/output and use bounce buffering (2 input buffers, 2 output buffers and a 'buffer full' interrupt). Your DSP, in order to keep up with the stream, needs to be able to do 1500 operations in 12 msec. For this, it needs dedicated floating point hardware (ALL DSP devices have this) and clock at a minimum of 125kops/sec - and chips to do this are sold by Analog devices and TI in job lots.

At least do a napkin mathematical analysis before you make a statement like this.

Re:You can have 2: cheap, realtime, or resolution.

[hankwang]

An analog filter doesn't peek ahead either, and is therefore limited in what it can do. But such a limited analog filter should be trivial to simulate as a digital no-peak-ahead filter.

Give me one example of something that can be done with an analog filter which is not trivial to simulate in a zero-delay streaming digital filter.

Re:You can have 2: cheap, realtime, or resolution.

[Anonymous Coward]

If the sound coming out of your hearing aids is delayed by 12ms, your ability to locate items by sound and react to them is going to be completely borked. At best, you'll be stressed out and irritated. At worst, you'll feel disoriented and confused.

Is this true? 12ms is the time it takes sound to travel 4 metres. Is delayed sound worse than having no or limited sound?

One Word: Greed

[rueger]

Seriously folks, is there really anything else that bears discussion? It's about greed on the part of the companies that sell these things. Anything else you might hear are just excuses.

Re:One Word: Greed

[dumky2]

The greed story does not explain prices differentials.
Are makers of hearing aids more greedy than makers of other products?
Are consumers of hearing aids less greedy or demanding than consumers of other products?
How are those changing over time?

Re:One Word: Greed

[rueger]

Are makers of hearing aids more greedy than makers of other products?

That's entirely possible.

Are consumers of hearing aids less greedy or demanding than consumers of other products?

Irrelevant to the discussion if there are no other alternatives. A more interesting question would be: How many people live without hearing aids because they simply can't afford them. Like the x million people who do not have insurance to pay for a $2000 hearing aid.

Re:One Word: Greed

[n6kuy]

"It's about greed ..."

Well, clearly we need even more onerous laws and regulations.

Re:One Word: Greed

[BooMonster]

Thanks for that. Tell us more about how you refuse raises and interest income because it's the Right Thing To Do(TM).

Other reasons???

[Anonymous Coward]

Are they priced too high? Probably.

But take a look inside. The custom ICs, packaging technology, and the manufacturing techniques required to jam what is effectively a small computer into your ear makes cell phones look like stone-age technology. These guys measure board space in square millimeters - and if there is more than one or two empty mm^2, they try to trim it.

Add in all the regulatory compliance garbage, total volumes over a product lifetime that are probably less than a typical 2 week run of a cell phone and you have a pretty high cost per item that you need to overcome.

two words, no hyphens

[Anonymous Coward]

Regulatory capture

We could all say the same thing about...

[blahplusplus]

... expensive internet, and other industries where we get robbed like for instance SHOES and clothing. Do nikes really costs $100+ dollars to make?

Re:We could all say the same thing about...

[Anonymous Coward]

No, they cost $10 for kids to make in a third world country (including materials, shipping, etc). But $90 to advertise (those sports celebrities aren't cheap).

Basically they spend $90 in advertising to convince somebody to pay $100 for them.

DSP is the answer

[used2win32]

I have been saying this for a while.

I think the manufacturers have a racket here. What we need is for a small startup to use some DSP technology and create a brand new low latency hearing aid system. They could customize the audio output for frequencies and percentages based on your hearing test.

The downside? It would probably be another patent mess. I am sure the existing manufacturers hold many patents on this and would hate for a competitor to come out with individually customized audio output, for each customer, for a couple hundred bucks (or a least less than a grand).

Re:DSP is the answer

[Anonymous Coward]

DSP is what they use already, and building as dsp that small and low power is not something you do in you average power hungry PC cpu process

custom fitting costs roughly $100

[Chirs]

Testing and configuring can be done in an automated way using the marvellous capabilities of computing devices.

I can buy a home theater receiver for $350 that will automatically EQ my room and apply fancy filtering. There's no way it costs thousands to do the same in a hearing aid.

Re:custom fitting costs roughly $100

[Americano]

And if you had to pay a trained audio engineer to come to your house, test your room, and program the receiver for your room... the total cost of that receiver would be a hell of a lot more than $350, because you'd also have to pay for his time & expertise - which is what you're paying for with the audiologist who tests & configures your device. You don't just hand people an instruction manual and say "click this button and wait 30 seconds," with a hearing aid, because the device cannot customize itself to the individual's specific hearing profile, because it has no way of determining what that specific hearing profile *is*.

Re:custom fitting costs roughly $100

[CastrTroy]

Sure it does. The audiologist just follows a script anyway. Play a bunch of sounds. Record whether or not the user can hear the sounds, Adjust accordingly. I'm pretty sure that you could create a computer program that would automatically adjust a hearing aid to fit a person's specific hearing profile. You could probably rerun the calibration every month, in order to fine tune the device, and account for any changes in the patients hearing. It would probably work better than an audiologist because going to see one is time consuming and expensive and many people probably avoid it even though it might help their hearing.

Re:custom fitting costs roughly $100

[Firethorn]

Hearing aids are right in the ear. It's been mentioned that many today have bluetooth. With that you should be able to hook it up to a computer and, sitting in a quiet room* follow the instructions given on the screen.
Stage 1: Click when you hear a tone.
Stage 2: Which is louder: Tone A or Tone B?
Stage 3: Which is clearer: Audio A or Audio B?

Outside of unusual circumstances that should be enough to 'dial in' the hearing aid very well, in under an hour, without assistance.

Excepting this, looking at what's going on - the devices themselves are over a thousand, and that's WITHOUT developing and programming in a custom hearing profile. That part would be a separate bill.

*DQ's my computer room, but a tablet should work excellent.

Re:custom fitting costs roughly $100

[Americano]

Awesome, sounds like you've got an amazing business model dialed right in, and you really understand what's involved in the design, construction, and operation of assistive devices. I can't wait to see your $299, high-quality hearing aid hit the market.

Re:custom fitting costs roughly $100

[Americano]

Okay, so now you've added R&D costs for a home-configuration device, and need to test and certify IT to make sure that it's not accidentally blowing out someone's ear drums, and you need to support it on dozens of different devices, and make sure it's secure (bluetooth hack + self configuring = your $1600 hearing aid is bricked). I'm sure that will drive down the costs of the device signifcantly.

The devices cost "over a thousand dollars" because the devices are complex pieces of integrated circuitry which have to operate continuously, reliably, in a hostile-to-electronics environment (the ear canal isn't exactly a cool, dry place), be comfortable, energy efficient, and safe, and last for a minimum of several years.

This argument that "these things should cost way less" is silly - they're NOT phones, they're NOT tablets, they're not laptop computers. They're highly specialized devices, selling to a limited sized market, with much stricter operating parameters, and high efficiency and safety requirements. Relax all of those, and perhaps you can make one cheaper - but it's going to be less reliable, less durable, less safe, and generally not a very satisfactory experience for someone who actually needs the device.

Re:custom fitting costs roughly $100

[BooMonster]

As soon as the market becomes aware of his product, some nice people from the government will contact him and let him know that he is selling an UNAPPROVED Medical Device (TM) and if he doesn't stop immediately that they guys with the badges and guns will come over to his house and MAKE him stop.

Re:custom fitting costs roughly $100

[BooMonster]

They're a microphone, a speaker, a circuit board, a battery, and a case. Sometimes a radio. Add in a computer program (99 cents at the App Store) and your price is maybe $30. You could replace your $30 Hearing Helper twice a year for sixteen years for a thousand dollars. Or get the Hearing Helper Deluxe for $60 for once a year.

I hear they're coming out with the iListen for $240 that will last for four years, too! It comes in colors!!!11!

Re:custom fitting costs roughly $100

[Americano]

If they're so cheap to design & make, then surely you could go start a company to build one, sell it for like, $200 a pair - a STEAL in the current "overpriced" market, after all - and make millions by disrupting the market and breaking the stranglehold of these colluding companies? After all, they're "just" a microphone, speaker, circuit board, battery, and case... right?

Or, maybe, you have no idea what's actually involved in the design and manufacture of such a device, no clue what you're talking about, and are behaving like a PHB who assumes that anything he doesn't understand must be trivially simple.

Re:custom fitting costs roughly $100

[Americano]

No way! Surely he's considered the cost of certification and testing in his estimates of how cheap it would be to produce this device!

After all, he's told us how simple it is - surely he's aware of all the legal requirements such a product is subject to?

Incidentally, I find it incredibly amusing that so many on slashdot - where libertarians are routinely ridiculed and mocked - love to pull out the "anything expensive in a regulated field is expensive ONLY because of government interference," argument.

Re:custom fitting costs roughly $100

[CastrTroy]

That's kind of my whole point. Bearocracy and legal requirements have gotten in the way of letting technology help out a large number of people. These devices aren't expensive for any other reason than the fact that they have to be certified by someone who wants all these devices to cost more than they should. These devices aren't really that complicated and could be sold a lot cheaper than they are. I'm surprised you don't see more unapproved devices being shipped over from China or elsewhere.

Re:custom fitting costs roughly $100

[Firethorn]

If they're so cheap to design & make, then surely you could go start a company to build one, sell it for like, $200 a pair - a STEAL in the current "overpriced" market, after all - and make millions by disrupting the market and breaking the stranglehold of these colluding companies? After all, they're "just" a microphone, speaker, circuit board, battery, and case... right?

Regulatory capture. I'm not going to say that they'd be $200/pair, going by what I'm looking at I'd say more $600/pair. A lot of plain bluetooth earpieces go for over $100.

The expensive part today isn't so much designing a hearing aid. The expensive part is designing one in such a way that it gains approval from the FDA and other country's equivalents.

Re:custom fitting costs roughly $100

[Firethorn]

Okay, so now you've added R&D costs for a home-configuration device, and need to test and certify IT to make sure that it's not accidentally blowing out someone's ear drums,

I was addressing only the configuration of such a device - not making it cheaper. Somewhere else somebody mentioned that the FDA shut down a homebrew EQ testing program. Such a program shouldn't be that expensive.

The moment you said 'Certify' you blew it though - remember, we're talking about a theoretical situation where the FDA isn't involved. No FDA - no certification necessary, no regulatory capture, costs go down. Despite this, I don't actually support NO regulation, just a 'we need to be a lot smarter about this, people'. Because the FDA really needs to streamline and update it's tests. Right now it's not concerned about security at all - wasn't it just a couple weeks ago that they found a pacemaker could be hacked remotely, potentially killing the person it was in?

The problem you have with the FDA is that it's so complex to gain approval that it slows adoption to the point that it's fairly frequent that common user devices gain functionality far faster than the FDA approved medical devices can. Thus you get a smartphone with app X being able to do task Y better then the medical device that costs thousands and is designed solely to do Y.

As for 'blowing out somebody's eardrums', well, that's what safety levels would be for, 'dozens of devices' would be more like 3, and being able to brick it through a bluetooth hack would be fairly difficult if the only configurable thing about it is the EQ settings, and if you wipe those out the fix is reloading the proper EQ from the settings saved in the computer at home.

Re:custom fitting costs roughly $100

[Americano]

No, they are expensive because they are complicated, detailed, tiny pieces of electronic gear, that have to work reliably, safely, and comfortably for 12-16 hours a day, for years at a time, with only an occasional battery change to keep them going.

Your assertion that they're "not that complicated" simply shows that you don't have the first clue what sort of components, design work, and engineering goes into them, and you haven't the foggiest notion what the market they're selling into looks like - hint: low volume, low numbers. This is not a "mass market" device where you can hope to sell tens of millions of units per quarter like an iPhone or a Nexus. If a manufacturer owned 100% of the market, the numbers I've been able to find via Google suggest that about 7 million units are sold *globally* each year. And, there are a handful (5-6) "major" producers of the devices - which means any single producer can probably expect to sell about a million a year.

Amortize millions dollars of R&D (chip & circuit design, programming, testing - a single decent engineer is going to run you a quarter of a million dollars in salary, benefits, and related operating costs - perhaps more if they have a particular expertise in the circuitry required in a hearing aid), marketing, and manufacturing ("Hi, chip fab facility, we'd like a production run of 50,000 of our chip." "Okay, but that small a number is going to cost you extra.") across that number of units, and build in a reasonable profit for manufacturer & retailer, and you'll understand that these are expensive devices because they are expensive, and expertise-intensive, to produce.

Re:custom fitting costs roughly $100

[CastrTroy]

Exactly, they have the entire design backwards and are stuck in their old ways. They are trying to stuff all the electronics into this tiny little thing you put inside your ear. Instead, you could put just a small bluetooth speaker inside your ear, which would be really cheap, and have all the smarts located in some other device similar to a phone (or possibly even a phone) that you carry around in your pocket. Sure in the US you could get a large percentage of the hearing impaired to pay thousands of dollars for these devices. But what about China, India, and other less well off countries. Most people there probably go without because there is no way they could afford thousands of dollars for these devices. There are huge untapped markets because the current manufacturers are going about things all wrong.

Re:custom fitting costs roughly $100

[Americano]

They are trying to stuff all the electronics into this tiny little thing you put inside your ear.

Yes, because it turns out that that's the lowest-latency way to design a hearing aid. They used to have external packs you could carry around connected to the speaker in your ear by a cord, then they had over-the-ear units, where the processor and battery were behind the ear, but connected to the speaker in your ear by a short wire as well. They moved away from those, because as miniaturization allowed them to put everything into the ear, they found that the units performed faster - and this is a pretty important feature for a hearing aid. But you already knew that, I'm sure, since you've come up with a revolutionary new way to design them.

Bluetooth introduces a ~.5s latency into the communication channel. Have you considered the effect of that on hearing? These are very much "realtime" dsp systems - they require low latency to work well, or what you're hearing will continuously be half a second behind what you're seeing happening around you - very disorienting and difficult to adjust to for someone who's deaf. But no doubt you've got an easy, hand-waving assertion to make about that, as well.

Have you also considered the security & interference characteristics? Wireless devices need to be shut off in medical facilities - anybody who's wearing a hearing aid will have to be effectively deaf whenever they go to the doctor's office. And god forbid somebody walks by with a device that emits interference on bluetooth frequencies - anybody in range would immediately lose their hearing.

You seem to think that these are trivial problems to solve: they are not. hearing aids are, in fact, very complicated pieces of engineering that have to make lots of tradeoffs between performance, durability, reliability, and ease of use. There's a reason why the industry has moved to in-the-ear, and away from the "speaker, separate processing unit connected via wireless communication" model you're describing - it introduces latency, weight, attack vectors, points of failure, and engineering and design work that still must be paid for.

There are huge untapped markets because the current manufacturers are going about things all wrong.

Easy to say for an armchair quarterback. If it's so easy, and it's so much a guaranteed blockbuster product, I can't wait to see your offering hit the market. When should we expect to see it available, and what price point do you imagine you'll be able to sell it at - $99? $199? $49?!

Re:custom fitting costs roughly $100

[Americano]

Bluetooth introduces a fair amount of latency. Realtime dsp's (and the people listening to their output, and relating what they hear to what they see going on around them) don't like latency. It's also subject to interference. Realtime dsp's (and the people listening to their output) don't like interference.

Bluetooth is NOT an adequate solution for connecting processor to hearing piece for a hearing aid, which is why they are not using it. Why do novices always assume that the experts haven't chosen to use a technology the novices are familiar with because of a sinister conspiracy? Why is it never assumed that the experts may just know what the hell they're doing, and have considered the technology, and found it lacking for the purposes of the device they're building?

If your mom showed up at your job and started telling you, "I don't know why you don't just use that Windows thing, Windows is great, I love Windows, everybody should use Windows, it comes WITH your computer anyway! It's so much easier, and better," wouldn't you get annoyed by that? Because that's kinda what you're doing here - prescribing a one-size solution to a problem domain you really don't know anything about, and haven't bothered to try to understand.

Re:custom fitting costs roughly $100

[Americano]

The problem you have with the FDA is that it's so complex to gain approval that it slows adoption to the point that it's fairly frequent that common user devices gain functionality far faster than the FDA approved medical devices can. Thus you get a smartphone with app X being able to do task Y better then the medical device that costs thousands and is designed solely to do Y.

Do you really want the performance of your hearing aid to be subject to the processor load on your fucking smartphone? Do you want to randomly lose your ability to hear because your phone starts ringing, or some other app on your phone wore down the battery and now longer has a charge? Even if you MADE something like that and offered it in the market, nobody would buy it!

These are not "convenience" devices that people can go, "oh well, I guess I just can't hear for a couple hours until I can recharge my phone." These are assistive devices that people rely on all day, every day, for critical functions of living. Want your hearing cutting out just as you're crossing the street? Just as you're in the middle of an important talk with your spouse or your boss? Would you buy a device that that was one of the "features" of? This is a single purpose device because it's an IMPORTANT FUNCTION that many people rely on to make it through every minute of every day.

Bluetooth, as I mentioned in another post in response to you, also opens up attack vectors (hand-waving the concerns away is a non-solution), adds enormous amounts of latency to the device, and also adds a huge amount of complexity, to collect incoming sound, stream it to the processing unit for processing, process it, and send it back to the earpiece. You weren't thinking of using the phone's microphone, were you? Because if it's in your pocket, you're not going to get very good sound.

I'm not sure why you think that it's an adequate solution, or that it would somehow magically drop the price, but I can assure you it would not. They are expensive because they are complex, require a high degree of reliability, and must be durable, energy efficient, and fast. "Just add bluetooth" changes none of that - especially when you consider that you can easily spend a couple hundred dollars on plain old consumer bluetooth headphones just for listening to music.

Re:custom fitting costs roughly $100

[Firethorn]

First, your language and tone is unnecessary.

Do you really want the performance of your hearing aid to be subject to the processor load on your fucking smartphone? Do you want to randomly lose your ability to hear because your phone starts ringing, or some other app on your phone wore down the battery and now longer has a charge? Even if you MADE something like that and offered it in the market, nobody would buy it!

Beat that strawman! I count no less than 10 attacks on positions that I in no way hold, and your other post has another 4 or so.

Hint: I proposed only making the hearing aid configurable through bluetooth. That's a bit like complaining about not being able to play songs on an MP3 player unless you have it hooked up to the computer via USB. The only reason I suggested using BT is that apparently some aids are coming with it as standard. That gives you an industry standard interface to the device, that's primarily to allow the user to have his aid(s) provide headset functionality much like the standard BT headset that I use.

As for security, the easiest method I can think of besides the standard 'you have to press a button on the aid itself to enable pairing' would be to require a security code to be entered to change the programming, one that's hardwired into the device along with the serial number(4 digit pin isn't going to cut it). You might as well complain about the devices having BT functionality at ALL, because theoretically I could imitate the person's phone and fake a call to them. Perhaps with nasty noises. For some reason there aren't hordes of people out there looking to screw with somebody's hearing aids, apparently. Heck, there's not that much interference with BT headsets, and they generally lack any security.

To clarify - When I start talking about X, Y, Z type stuff I'm being deliberately generic. Deaf people have switched to texting over dedicated teletype type devices. Why? For the most part texting is faster, cheaper, and gets to their intended audiences better. However, other examples also exist, and for numerous disabilities/medical requirements/niceties.

"Just add bluetooth" changes none of that - especially when you consider that you can easily spend a couple hundred dollars on plain old consumer bluetooth headphones just for listening to music.

Just goes to show that you missed the context of my post - I was talking about aids that already have bluetooth installed on them. In the other thread it was originally YOUR response talking about $200, to which I replied that $600, THREE TIMES the price, would be more likely. And pretty much the very reason you state here - they ARE expensive little devices because they have to be so very good at what they do. When it comes to high end audio; price is pretty much what you're willing to pay(there's always somebody willing to indulge a sucker). But even if the hearing aides ends up being 4X the cost of a good set of BT headphones, that's still under a thousand, a third of the price of many aids.

But the hearing aid market is global, so volumes are actually pretty high. Because they're medical devices there's a lot of certification work that needs to be done to prove that they're worthy to be a hearing aid to the various government agencies. This is the 'regulatory capture' - Because they've been doing it for a while, meeting the regulations isn't very difficult for the current makers; but it makes it prohibitively expensive for a new player to enter the market. Add a dash of collaboration and they're free to charge in the thousands for their products.

Hearing aids at Costco

[Anonymous Coward]

The article also pointed out that if you buy your aids at Costco (as I did) you save at least 50% over the cost of buying them from a private dispenser. I foudn the audioloigist at Costco just as good (if not better ) than my previous guy - and saved about $3,000 on my two aids (2k versus 5k). Both my aids are mad eby Siemans and seem to have all the whizbang technologies currently available

to break it down

[doginthewoods]

when you buy an aid from a dispenser or audiologist, about half of the cost of the aid is his or her's profit, plus the free follow up visits. So all costs of maintaining an office are passed on to the end user. An audi doesn't sell a bunch of hearing aids - it's not like selling TVs - it's a low volume market. Because the CPUs are pricy to produce, due to relatively low unit sales, many makers share the same CPU, to spread out the R&D and production costs. Some companies like Siemens, can make their own chips. And aids makers are always working on faster CPUs, so the headliner aids are pricy, because the company is trying to recover their production costs before progress creates the next even better CPU, rendering the one they have "old tech". SO a hearing aid company can take its old out of date CPUs and put them in second and third line aids, and charge less, but, as always, if you want the fastest and newest, you gotta pay for it. It's a big race between all the aid makers, all the time. to produce the best aid. Note that, just like all digital audio devices, the fastest CPUs make the best sound, because they have the horsepower to handle it. So an aid company can get maybe three years out of a CPu before it gets outdated. IIRC an aid in raw materials is about $250, then it has to be assembled inside a custom ear mold or BTE unit, and the labor and programming and testing the aid adds to the final out the door cost. And the usual costs of promo and advertising and paying the beta testers, etc. But the cost is still high. A person can go to Costco and buy aids for about half of what an audi wills eel it for, because Costco hires audis on a salary, not on commission, so they are not saddled with having to sell aids to keep the business open. About US$3000 will get you a nice pair of aids.

Hearing Aids Cost Money?

[Anonymous Coward]

I thought they were free... oh wait, I live it Canada... my mistake

More than meets the ear

[Alomex]

A hearing aid is basically just a microphone and amplifier in your ear so

This is like saying that a Ferrari is basically a VW bug on a race track so why is it so expensive? [yay car analogy!].

A good hearing aid has a microphone, speaker, battery and amplifier which are 1/50th the size of the one in your cellphone yet deliver much higher quality of sound all while filtering undesirable sounds.

Yes, in my opinion they are overpriced, but arguing that they are just a microphone and an amplifier is just ignorant.

Re:More than meets the ear

[Anonymous Coward]

This is like saying that a Porsche is basically a VW bug on a race track so why is it so expensive? [yay car analogy!].

Both use an air cooled engine mounted be hind the rear axel.

Re:More than meets the ear

[Anonymous Coward]

This is like saying that a Ferrari is basically a VW bug on a race track so why is it so expensive? [yay car analogy!].

Actually.... you almost have it right, except swap FIAT / Lancia. There is a quite disturbing amount of Fiat and Lancia in each Ferrari - and not the new models either. I saw in a F430 Challenge the windscreen washer bottle out of a 1978 Lancia Beta sedan.

Here you go

[Chirs]

http://www.earplugstore.com/woodland-whisper-itc-ac.html

Of course the better ones are more expensive:

http://www.earplugstore.com/pro-ears-pro-fit-hunting-hearing-aid.html

Yes

[doginthewoods]

the CPU. The programming of the CPU. Writing the software to adjust the aids. the I/O devices. The interface. the cost of making the aid, especially if it is an ITE device, where the works have to be installed inside a custom made shell. Testing. Approval. Putting together a factory. I know a guy in NZ who has a great aid, but can't get it to market, because he doesn't have the cash to get it to market. It costs a lot.

Medical device

[Anonymous Coward]

Hearing aids are Class I regulated medical devices as per the FDA. That's good for one full order of magnitude price inflation.

In Oz

[godel_56]

http://www.blameysaunders.com.au/our-story Roughly $1300 to $2100 AUD including a software programmer.

One word reply

[Sycraft-fu]

Canada.

Check on hearing aid costs in Canada. You will discover they are very high there as well.

Re:One word reply

[Anonymous Coward]

Most hearing aid purchases in Canada are subsidized by provincial governments. The actual cost to most end consumers is almost nothing.

http://www.chha.ca/documents/Hearing_Aid_Subsidies_Across_Canada.pdf

Re:One word reply

[caseih]

That's because the socialized healthcare insurance systems in Canada typically don't cover drugs or medical devices except in certain cases (like diabetes, or if you are poor or elderly... except of course hearing aids). They mainly cover doctors and hospitals. Many Canadians buy secondary insurance to cover drugs and things like crutches, wheel chairs, and the like.

Re:One word reply

[houghi]

Spain as well. My father payed several thousand Euros for his hearing aids. It wasn't something they payed back. Generally he pays nothing for his healthcare.

Re:One word reply

[Anonymous Coward]

"Check on hearing aid costs in Canada. You will discover they are very high there as well."

Wrong direction...Go South.

When I needed new glasses, the price dropped significantly when I got to Los Angeles (I'm from the Pacific NW) and kept declining until I reached San Diego, at which point it nearly matched the prices in Tijuana. The interesting thing is that the brands were exactly the same all the way down the coast. The optometrists in San Diego had to match the prices in Tijuana just to stay in business.

When I lived in Alaska, people would wait until they got their dividend checks, then plan a family trip to Seattle or Honolulu for dental work--it cost less then half the price and the savings more then covered the cost of airfare (greatly discounted during dividend "season"). Perhaps the dude in TFA just lives in the wrong place?

Re:One word reply

[Anonymous Coward]

Doesn't surprise me. In the US I know I can get custom fit in the ear ear buds for probably $400, those aren't FDA approved and are just for listening to music for people who still have their hearing. Because they aren't medical devices, the regulation is less, but they also don't have to deal with the situations that regular hearing aids do. These just have to take whatever is coming out of the head phone jack and reproduce that accurately.

It wouldn't surprise me if there genuinely were $1k or more worth of electronics improvements involved with receiving and processing the sounds even before you start talking about regulatory approval by the FDA.

These ones here just for the plastic to fit in the ear are $149 and that doesn't include the cost of the fitting.
https://earsound.com/products/custom-headphone-earbud-attachments
At that price, I may end up getting myself some in the future, I've never had in ear earbuds that were at all comfortable.

I think a lot of people don't understand this

[Sycraft-fu]

Price doesn't scale linearly with units because there are fixed costs. If 10,000,000 units cost me $5/unit, that doesn't mean 1,000,000 units still cost me $5/unit.

The big fixed costs are R&D and setting up a production run. This can be substantial. 6-8 figures no problem. Well if this is spread over a hundred million units, no problem, it adds a minimal per unit cost. However if you are selling only 10 units, each until will have a massive cost.

So suppose product X has a marginal cost, as in parts, labour, etc, of $10 per unit. However there was a fixed cost of $5,000,000 in getting to ready to go. If you sell 50,000,000 units, you can sell them for around $40/unit retail (100% markup for the retailer, 100% markup for you, pretty normal). The fixed cost adds so little to the unit cost, $0.10/unit, you can more or less ignore it. However now say you are only selling 500,000 units. You've now doubled your per unit cost, so the final retail price will go up to $80, all because of that fixed cost.

Of course there's even more non-linear scaling due to supply and demand. As the price goes up, demand goes down. As such the price has to go up more to make up for that and you get a limit situation. So a doubling of costs leads to more than a doubling of price.

It is just how things go. Those costs have to be paid. You can't say they should just ignore it, real life doesn't work that way.

Cheap

[Anonymous Coward]

I read about a company that was trying to get startup capital to produce a $100 aid. They said that they could sell it along with a computer program whereby to user could adjust it. I am afraid that the CDC, FDA, or maybe even the BATF would find some way to ban it. It would be like the fellow who invented the 12 package tooth brush (one for each month), was ready to start distributing them, only to have a government bureaucracy suddenly pop up and declare the brushes a medical device. This called for all kinds of paper work and fees. He almost gave up but was helped by his brother through the mess.
As to these expensive hearing aid joints, I have about a 50% loss of hearing in both ears. I went to one of these places and they said that they could,at the very least, fit me with a $500 hearing aid. My ear doctor later told me that no hearing aids would be able to help me. Scam, anyone?

dumb question

[Anonymous Coward]

The question isn't why can't industry design a cheap hearing aid, they already have. As noted by the article the components are nearly identical to what is found in most cell phones and consumer electronics. They sell at an inflated cost due to third party payers, and the fact that they have to be FDA certified as 'medical devices'. You see ads on late night TV for 'Whisper 3000' and other such products for dirt cheap that perform the exact same function. They aren't certified as 'medical devices' and they are covered by insurance, therefore the market won't bear $2000 for those devices.

For more information

[EkriirkE]

You can refer to the repost from a few months ago: http://ask.slashdot.org/story/12/06/13/1828232/ask-slashdot-why-are-hearing-aids-so-expensive

You get what you pay for

[viking80]

You can get cheap hearing aids for next to nothing. A simple amplifier. If your hearing is damaged to a varying degree at different frequencies, and you want to be able to hear conversations, a better device will be custom made to remap the relevant audio to the right frequencies. This requires customization to each user and advanced digital signal processing. To select human voice, and filter away unwanted noise is also a demanding DSP task.

A good headset for music easily costs $500, and my sennheiser pilot headset costs easily $1000. and that is not customized to me.

Re:You get what you pay for

[Chuckstar]

This is a good point. It's possible that many people with moderate hearing loss are overpaying for aids that are overkill for their condition. For people with more difficult to address conditions, though, the cheaper ones just don't cut it. My dad has severe tinitis, with associated hearing loss.* He tried hearing aids at all price levels. Only some very expensive ones worked well enough for him to even bother with (couple thousand dollars per ear, but I don't remember the exact price).

*Recent research into tinitis seems to lean towards the hypothesis that I worded that backwards. The old hypothesis was that the ringing sound makes it hard to hear in that range. The new hypothesis is that the ringing is a side-effect of losing hearing in that range -- i.e. it is the equivalent of phantom pain when a limb is severed.

Re:You get what you pay for

[TheCouchPotatoFamine]

did you really just say you were dumb enough to buy 1000$ headphones? YOU - yeah you - you're not helping. (and dont give me your bullshit about how there is such a difference. all in your mind, richboy.

Re:You get what you pay for

[viking80]

I am actually pretty cheap. Good pilots headsets are expensive, but try a pair of regular digital active noise cancellation headsets next time you save $$$ by flying in the back of the cabin. Just putting them on even with no signal in removes all the ambient noise. The difference is heavenly, and if you try it once, you will never go back. If you do not understand what active noise cancellation read http://en.wikipedia.org/wiki/Active_noise_control,

It's quite simple

[Chris Mattern]

Thanks to insurance, the person choosing the hearing aid is very rarely the person paying for it.

Cheaper hearing aids were sold for awhile...

[Anonymous Coward]

It was about ten years ago when Sharper Image actually sold disposable hearing aids for a very reasonable price. What happened? The legal sale of hearing aids without a doctor's prescription was basically legislated out of existence. How dare someone sell $40 hearing aids to the general public! My ninety (at the time) year old grandfather loved them. I couldn't buy them in my state so had to drive to a neighboring state where they allowed the sale. Until they didn't any more. Can anyone say racket?

Personal audio amplifiers

[Torin Darkflight]

Less expensive alternatives do exist, but thanks to the FDA they're not called or legally recognized as hearing aids, but rather "personal sound amplifiers". Thus, any search for a less-expensive alternative is best done using that term.

No, I'm not talking about those cheap infomercial sound amplifiers that look like bluetooth headsets or small pocket-size radios with headphones. I'm talking about professional-quality sound amplifiers that actually resemble proper hearing aids in appearance. They do exist, because I have one, an RCA Symphonix. The FDA might not call it a hearing aid, but I do. That's effectively what it is to me, a hearing aid that I purchased over-the-counter at an electronics store, paying only $300 as opposed to the $1,500 my doctor was quoting me. Despite it not being properly tuned to my particular grade of hearing loss, it still works pretty damn well for my needs, and I've been quite impressed.

So, it is possible to purchase a decent "hearing aid" for a relatively inexpensive price. You just need to know where to look and what to look for.

How About Some Teardowns?

[Anonymous Coward]

And some parts lists and manufacturing cost estimates, like are done with the iPhones? Then, if it's found that a manufacturer is gouging, some concerted efforts by those of us who care about such things to embarrass the living shit out of those responsible until they shape the fuck up and stop taking advantage of people?

WTF Again?

[Osgeld]

http://ask.slashdot.org/story/12/06/13/1828232/ask-slashdot-why-are-hearing-aids-so-expensive
http://science.slashdot.org/story/11/09/09/2346233/is-there-a-hearing-aid-price-bubble
http://ask.slashdot.org/story/10/03/13/1916203/why-are-digital-hearing-aids-so-expensive

simple:
insurance
medical device
niche market

just because you are deaf, it doesn't mean that you are too blind, stupid and lazy to look at the last 3 years of the same fucking article with the exact same answers.

Re:WTF Again?

[epSos-de]

He was offered an unfair price. Here in Europe you can by them from 200 to 400 EUR and be good for another 5 years. Just buy them from Germany , where Siemens actually makes them. Amazon and eBay are good placed to look for it, but you can also write eMails to the vendors with German online shops. They will send the thing to you by DHL and you will have to pay import tax to the mail man directly, if they function the same way as they function in Germany.

18 tries...

[Anonymous Coward]

It took 18 tries to get to this page. It doesn't matter the underlying architecture, it's a crappy page design.

Anyway, iApple markets a application to do that using ear-buds. It can also do some Fast Fourier
transformations to sharpen the signal in real time. I think it's call iHearYou or something like that...

You're right, it doesn't exist. That should be very telling.... ...and sad.

The state of the art.

[westlake]

''The semiconductor industry traditionally reduces the cost of products by 10 to 15 percent a year,'' he said, but 'hearing aids go up 8 percent a year annually'' and have for the last 20 years."

The digital hearing aid was in its infancy twenty years ago.

There were two manufacturers in the nineties, now there are over twenty.

There are features and advanced signal processing schemes available in current digital hearing aids that do have significant advantages over those found in analog instruments.

Gain Processing. One of the primary benefits associated with flexible gain-processing schemes is the potential for increased audibility of sounds of interest without discomfort resulting from high intensity sounds. While this is more generally a benefit of compression rather than digital processing per se, the greatly increased flexibility and control of compression processing provided by DSP--such as input signal-specific band dependence, greater numbers of channels, and kneepoints with lower compression thresholds--can lead to improved audibility with less clinician effort. Expansion, the opposite of compression, has also been introduced in digital hearing aids. This processing can lead to greater listener satisfaction by reducing the intensity of low-level environmental sounds and microphone noise that otherwise may have been annoying to the user.

Digital Feedback Reduction (DFR). The most advanced feedback reduction schemes monitor for feedback while the listener is wearing the hearing aid. Moderate feedback is then reduced or eliminated through the use of a cancellation system or notch filtering.

Digital Noise Reduction (DNR). This processing is intended to reduce gain, either in the low frequencies or in specific bands, when steady-state signals (noise) are detected. Although research findings supporting the efficacy of DNR systems are mixed, they do indicate that the DNR can work to reduce annoyance and possibly improve speech recognition in the presence of non-fluctuating noise.

Digital Speech Enhancement (DSE). These systems act to increase the relative intensity of some segments of speech. Current DSE processing identifies and enhances speech based either on temporal, or more recently, spectral content. DSE in hearing aids is still relatively new, and its effectiveness is largely unknown.

Directional Microphones and DSP. The ability of directional hearing aids to improve the effective signal-to-noise ratio provided to the listener is now well established. In some cases, however, combining DSP with directional microphones can act to further enhance this benefit. In some hearing aids, DSP is used to calibrate microphones, control the shape of the directional pattern, automatically switch between directional and omnidirectional modes, and through expansion, reduce additional circuit noise generated by directional microphones.

Digital Hearing Aids as Signal Generators. Since digital hearing aids have a DSP at their heart, they are able to generate--as well as to process--sound. Current digital hearing aids use this capability to perform loudness growth and threshold testing in order to obtain fitting information specific to an individual patient's ears in combination with a specific hearing aid. Sound levels also can be verified through the hearing aid once it is fit. This technology has the potential both to increase accuracy of hearing aid fittings and potentially streamline the fitting process by reducing the need for some external equipment.

Digital Hearing Aids: Current "State-of-the-Art"

The geek will focus on DSP --- which looks easy enough, at least on paper --- and forget every other aspect of the problem. The microphone, for example.

A partnership supported by NIH and NASA, emerging from the 1995 survey of federal agencies, could potentially revolutionize the technology used for di

Avoid the ripoffs, buy them directly

[DrHeasley]

from the Chinese manufacturers. Prices start at around ten bux. For 825 listings of various 'in ear' aring aids, run a search at aliexpress.com. I would definitely try a couple of these devices before I'd shell out thousands of bux to Philips or Siemens for a device that was probably made in China anyway.

Re:Avoid the ripoffs, buy them directly

[dadioflex]

http://dx.com/s/hearing+aid dealextreme is kinda consumer friendly. I haven't bought anything off aliexpress.com but I have bought a lot of very cheap crap off dx.com. Is it an alternative to everything else? Obviously not. Is it an alternative? Yes.

I can't promise that you'll get a custom-fitted, perfect hearing aid off dx.com. But, before you pay $10k for one you should probably browse there to see if it's a generic hunnerd dollah device. If some grubby crooks get outed in the meanwhile, all the better. I'm a capitalist at heart but I want to deliver value to my customers. If I can't do that, then I'd sooner stay in bed.

Some people want these Chinese sites to be secret, or argue that they're "taking jobs". Truth is, they want to protect their sources and charge you old money for new money.

Failure to negotiate properly

[Anonymous Coward]

The proper response it to tell the lying fuck, that you are going to another Toyota dealer, and to have a nice day.

You would be amazed at how much power NO has.

Insurance?!

[Anonymous Coward]

Well, I'm not 65+ yet in the US, but I'm unaware of any insurance in the US or Canada that covers the bloody things. They're complex devices, rather useful to hear, say, women talk or have the ability to detect sound locations. Given the relative complexities, they're not any more overpriced that my bifocals which run 400-600. People charge for this crap because they can. Most folks can't do w/o glasses. They seem to have no problem saying "what?".

Re:Insurance?!

[aurizon]

The shape of the ear allows for directionality.
You can buy bifocals for $200 or so online.

One word

[shiftless]

Government

Liability

[Anonymous Coward]

Law suits bring up the cost of anything medical device.
Thank Lawyers.

$10 verses $2,000

[Grayhand]

Funny how you can get a hearing enhancing set up for $10 but a fits in ear amplifier casts $2,000. I remember hearing aids for the mid to late 70s that were bulky but worked and average people could aford them. A cell phone if you had one was the size of a lunch pail. Now cell phones are tiny and dirt cheap but hearing aids are smaller and outrageously expensive. It's pure price gauging. Sorry but a computer chip will set you back a $100 but the same thing that does a 1/100 as much runs you $2,000? It's price fixing and everyone knows it but medical expenses are more sacred than religion in this country.

Re:$10 verses $2,000

[dadioflex]

Suppose someone told you that you could save ten thousand dollars a year buying what you already buy. You'd listen, right? Suppose someone told you that you could avoid paying ten thousand dollars a year. You'd listen, right? Suppose someone said there was no need to pay twenty thousand dollars a year, for what the rest of the world gets for free? Communists, right? Your system is screwed. On the plus side, it only costs twenty thousand dollars a year to figure that out. Get a passport.

Not quite

[Sycraft-fu]

They have to do dynamic range compression and limiting as well, and the good ones are doing it in each frequency band separately. Let's see a parametric multi-band dynamics processor, ya I know of one of those, the Waves Linear Multi-Band is a 5-band unit that meets those spec (http://waves.com/content.aspx?id=209). It is a software plugin that requires a powerful computer, and a DAW to host it. Price is about $150.

Gee, I wonder why if you put something like that in to a small package, add a microphone, speaker, other associated electronics, add more processing like directionality (the good ones lock on to the direction speech is coming from and enhance it), compatibility with other devices like cellphones and so on, it ends up costing more.

Oh, and then there's all the medical regulation, of course.

One word...

[pubwvj]

Insurance. Because insurance pays for so many the price is ultra high. People don't question the cost when someone else is paying. Get rid of insurance and the price will drop as sales dry up.

You say it: aid

[Anonymous Coward]

You need the help, so you depend on them. They tell the price for their help. Welcome to capitalism.

I love these gotchas, they fit the subject too often to be by accident.

I'd mod this up if I could

[Sycraft-fu]

People need to look around, notice these things are expensive everywhere, and then maybe think that it isn't the evil US healthcare system causing it.

When there's a massive price disparity between the US and Canada or the EU, like for say prescription drugs, well then you begin to suspect something is afoot. I mean they should be rather similar, most things are (particularly when you adjust for taxes that are in the price).

However hearing aids are expensive everywhere. That indicates the opposite: That they really ARE expensive and that is what it is.

Damn those hearing aids are cheap!

[Anonymous Coward]

OMG You can get a top of the range hearing aid for $2,000! That's amazing. It would be well worth flying first class from Australia to the US to buy hearing aids. The bottom of the range here is twice that top of the range price!

Re:You disgust me

[tmosley]

No, it's the ones who feed them that are the problem. Those who create perverse incentives are the ones who break systems. You can't fault a person for maximizing their gain under the rules of the system they live in.

Re:You disgust me

[shiftless]

Sure I can. It's called having principles. Anyone who sucks at society's teat and "milks it for all its worth" "gettin mine" "while the gettin's good" is a piece of shit, and deserves for the force of history to come down on them like a ton of bricks when their jig is up. Can't wait for it.

Fixed that for ya...

[Huggs]

Why Won't Industry Design an Affordable Hearing Aid?

After losing their second hearing aid, a guy I know just purchased one of those compact sound amplifiers used for hunting. Couple hundred bucks and he says it works just fine.

Re:You disgust me

[tmosley]

You can hate your fellow man all you like, but your hate will never change anything. Might as well slice the head off of a hydra as kill a welfare recipient. The money you "save" by doing so will simply be redirected to some other form of welfare.

Problem:

[Anonymous Coward]

Most people needing hearing-aids don't have parents from which to freeload, and even assuming the teen pays the bill them self, using your plan the senior would pay $80 a month for 2 years, a sum of almost $2000!

Hearing aids span a wide spectrum of quality and many decent ones aren't actually that expensive. Take the
$329.98 MDHearingAid Acoustitone PRO Hearing Aid for example. You even get a 45 day allegedly risk free trial.

Or go ultra cheap with the $8.99 SSI Mini Hearing Enhancement System (Batteries Included)

You probably won't get "$8,000 hearing aid" performance out of them, but when you lose them at the park you won't be near suicidal over it.

The hearing aid racket

[aurizon]

The whole hearing aid racket is enabled by FDA approval processes that provide a very high "barrier to entry", by that I mean that if you invented a hearing aid that cost $1 to make you could not sell it until you had gone through the arcane FDA approval process. This process is supposed to protect us all from bad things happening to our ears. It does prevent those bad things. Another barrier to entry is the network of professional audiologists who have no interest in selling you a $1 hearing aid, but are happy to sell you a $1 hearing aid for $1600.
The current situation in hearing aid sales is the low cost hearing aid on the market probably cost under $25 to mass produce. You load the compensation curve of gain versus frequency into the built in ROM and sell it for that $1600. The maker might sell it to you for $600. Find another maker?? Good luck the barrier to entry might cost $2 million for all the tests and approvals. So you sell a million, that is only $2 each.

The ones used in China are perfectly good and you can get the ones with the programmed roms for $50 or so, plus the cost of the audiologist making your gain versus frequency curve. US audiologists can probably make you the curve for $50 of test time, but they would prefer to sell the $1600 device, so avoid telling them. Just says you want the curve. Now where to buy the hearing aid? Buy on Ebay and look for high + feedback

Two Words

[BMOC]

Unchecked Monopoly The reason hearing aids are allowed to get so high is that there's no bottom-up challenge. There's no bottom up challenge because entrenched companies have gamed the system.

Complain, complain; grow up

[holophrastic]

If it's honestly so over-priced, then I'd think the solution to your problem is quite obvious. You're saying that it's basically a consumer-electronic device and should be very easy to build cheaper. So do it. Start your own business, under-cut the entire existing industry, and be happy on all fronts.

Why would you complain about other people running their own businesses their own way? You get to do the same. And you'll be very successful.

Let me know how it goes. Stop complaining to me otherwise. If you sit and do nothing about it, then clearly you must be satisfied with the situation.

So?

[Anonymous Coward]

That's great if you're working an office job or something. That's significantly less great if you're trained in some sort of field where not being able to hear is a potentially lethal disability -- construction, some engineering work, some factory work -- hell, I wouldn't even want to be a parking attendant if I couldn't hear the cars; there've been too many times when my hearing was the only thing that saved me from getting creamed by some douchbag who didn't look before he pulled out of a parking space. If your job includes dealing with the public, you're probably going to have problems too: most people suck at speaking to deaf people who can lip-read, and, of course, not being able to get feedback hurts verbal communication the other way, too. You can't work a customer service desk in a store if you have to have customers write out their communication -- or even if you just have to do so.

Basically, what you're saying is that it's better for a person to have a $15K McJob and the government not paying for their hearing aids (but now giving them plenty in public assistance and tax credits,) or you can have someone working a $50K+ job with real benefits and still getting net revenue from that taxpayer even after paying a grand or two every four years for hearing aids.

What's better for the welfare of the population and the country itself?

Two words: dumb customers

[ShanghaiBill]

Certainly the free market isn't driving down the price...

The free market only works if customers aren't stupid. The guy in TFA goes to one reseller, and looks at hearing aids from one manufacturer. Yet even he admits that he could get one for far less "on-line", but for some reason he doesn't fee that is an option. Why not?

Two months ago I bought a hearing aid for my father-in-law from Amazon for $329. He describes it as "fantastic". So TFA's claims that nothing is available for less than $2000 is clearly nonsense.

Re:Two words: dumb customers

[Anonymous Coward]

This is the reason prices don't go down. If more people did like you did then the market would have to drop the prices, else the company's wouldn't be able to profit any more.

Re:Two words: dumb customers

[AchilleTalon]

Yep, there is plenty of hearing aids in the range of 300$ to 1600$. Here, in my country, the hearing aids are covered by the medical insurance plan from the country. So, the government agency is negociating prices with manufacturers and I can ensure you, no hearing aids above 500$ each are on the list. However, you must know they are not the bleeding-edge products from these companies, they are the end of line products. Even, they are no longer advertised on their respective websites. However, due the negociation for a large number of hearing aids per year, the governement is able to drive down the prices. The contract with the manufacturers include maintenance plan for three or six years.

Obviously, the companies don't want to sell these on the free market and are trying to sell top of line products instead at the higher tag price with the large profit margin.

Re:Two words: dumb customers

[SirSlud]

Since that's a lot of information, and welcome at that, why wouldn't you specify your country?

Re:Two words: dumb customers

[Anonymous Coward]

Your claim that the TFA's claim is nonsens is nonsens. The cheapest he found was 1600 not 2000

Re:Two words: dumb customers

[nukenerd]

Shanghai Bill wrote :-

The free market only works if customers aren't stupid.

Indeed. Assuming that customers are informed and clever is part of the Grantham Grocer Fallacy

Re:Two words: dumb customers

[c 0xFF]

I can't help hut feel that the insane medical system of my country (the US) is subsidizing the cost of hearing aids in your country. You're welcome, I guess.

Re:Two words: dumb customers

[robbo]

Who are the customers? Consumers don't readily grasp the relationship between coverage and premiums, so they don't blink at their insurance paying out thousands of dollars. Insurance companies don't mind paying out thousands of dollars because they can just raise premiums. Employers scratch their heads and wonder why the cost of insurance is skyrocketing but, no worries, we'll just push down wages to make up the difference. And here we haven't even scratched the surface of collusion between insurers and congress.... so it goes.

Re:Two words: dumb customers

[shaitand]

The free market only works when the price the market will bear is less than "anything I can afford." At least it only works for consumers in that case and that is what people are willing to pay for essential healthcare. It has something to do with that "essential" part. The only morally tolerable profit one could make in this field is nothing because anything more means denying essential care to those who need it. Nothing isn't fair to the providers. Is the free market really the place to turn for a service that can not be morally profited on or denied under any circumstance to those who need it?

Even $329 is not exactly inexpensive and it is missing the capabilities of the advanced models. According to the engineer who buys them the parts that go into that device are $100 in LOW VOLUME. The difference between the low end model and the high end in terms of tech is just software. I can get free working equalizer code for a $8 pic micro-controller right now that can handle the 'advanced' capabilities and likely a noise reduction algorithm as well.

Re:Two words: dumb customers

[RockDoctor]

Extensive investigation showed that two countries top the list of probable locations. Neither is as renowned as the US a for gouging the ill, though one at least competes vigorously with the US in the "we'll perform any sort of business for money" stakes.

Bow before my one-click hacking prowess! Can I have your mother's maiden name and her credit card number?

Re:Two words: dumb customers

[RockDoctor]

Most American corporations I've worked with (many, many of them), go to strenuous efforts to tie the use of one product or service to needing to buy many instances of a consumable to actually make it work. In my industry, we call it "repatriation of profit". Cartel activities are deeply expected. It's one of the things to watch out for in the bidding process.

Having said that, I'd be surprised if Siemens (a German-based company) were to be "repatriating profit" to the US. Indeed, I'm moderately surprised that they operate at all in such a litigious health-care system. Obviously the amount by which they can rip-off the American public makes the danger of carrying out business in the country worthwhile. Cunning! And all in the finest traditions of business "ethics"!

Re:Two words: dumb customers

[stargrazer]

Don't be too surprised about German companies happy to milk the American public. Fresenius is all over here providing $3K a shot twice-a-week dialysis services using their own equipment and their own disposables. I imagine the company uses the salaries, rent and lawsuits as a direct write-off against US taxes while making mint selling themselves supplies.

I've seen commercials from litigious lawyer firms capitalizing on the mistakes made by this industry, but I doubt most of the patients/clients have much of a leg (actually, any legs at all) to stand up with in court as they all pretty much end up dead sooner or later.

It's said the only worse job for a nurse or technician is working in a child oncology ward.

Re:Two words: dumb customers

[Pseudonym]

I can't help hut feel that the insane medical system of my country (the US) is subsidizing the cost of hearing aids in your country. You're welcome, I guess.

I doubt it's the cost of the product they're subsidising.

Re:Two words: dumb customers

[Specter]

+1

Re:You disgust me

[Montezumaa]

Do you not understand(obviously, you don't) that Social Security Disability(SSD or SSDI) is funded by, and only paid to, those that have worked and paired into that system? Do you not understand that the amount received each month is based off of how much you paid into the system? You need to actually learn about the topics you attempt to discuss, prior to making yourself appear unintelligent.

I am on disability myself. I previously worked in law enforcement, where I was hurt while working, and I cannot walk without a cane. I also live in an immense amount of pain. On good days, I am hovering around a seven, on a one(least, or no pain) to ten(intolerable, excruciating pain, the worst possible pain) scale, and on bad days, I cannot come down from ten. Today is a good day. I tend to have far more bad days.

Just because I worked in government does not make me more deserving of receiving benefits from one of the programs I paid into. There are a lot of people that need to be receiving SSD benefits, and there are many gaming the system. That is the failure of government, not our receiving benefits from a program we gave a lot of money to.

The people who only qualify for Medicaid(free, Mdicare is not free), Supplimental Income(free, for those not meeting a minimum, which is $678 a month), and other non-paid programs, are the problem. I understand that people fall on hard times, but far too many people "game" the system, and take advantage of money and programs they shouldn't have access to. If you want to target your angst somewhere, target it there.

I worked hard, and paid into the Social Security program by age 26 that most people will not have paid until age 45 to 50. So, spare me the uneducated angst over a topic you obviously have no business discussing.

It's NOT an amplifier.

[Anonymous Coward]

TFS, and parent (and all sorts of other people) apparently don't have a clue.

Hearing aids are NOT amplifier-based, and haven't been for 20 years (30 years?).

They shift frequencies from ones you can't hear to ones you can hear, and do all sorts of other fun things like that.

While still not "extremely complicated" in principle, neither is your automobile, yet you still pay $15K+ for that.

The top of the line ones are crazy expensive because they're top of the line. Same reason you can buy a $4000 computer, top of the line stuff is more expensive because it's brand new and few people buy them.

THIS

[Arathon]

THIS. I read through wayyyy too many comments before someone pointed out the obvious. Thank you. I can go to sleep in peace, knowing that at least *someone* on the Internet is *not* wrong.

My experience: I question whether this is true.

[farmkid]

I've found that hearing aids have increased in function and greatly decreased in cost.

A caveat: I've bought my hearing aids with my own funds, so the many comments about government, insurance companies and so forth may be accurate for those who obtain them through other sources, but for those who deal only with the private providers have seen many technological improvements for less money.

I bought my first pair (yes, two ears) in about 2000: they had all the computerized noise cancellation/augmentation stuff available at the time and cost about USD 6000 for the two. I bought a newer, more powerful pair about six years later for about the same amount; that is improved technology at the same price.

My latest pair, bought about three years ago is functionally FAR superior to any I've had before, and cost 1/3 as much. Yes: USD 2000 for the pair. This last purchase really emphasized both the technology improvements AND cost reduction that have been available in recent years.

subject

[Legion303]

"hearing aids go up 8 percent a year annually"

Interesting. How much do they go up a month annually?

Re:subject

[dadioflex]

I want to buy hearing aid bonds.

Competition is growing

[Roblimo]

I don't use hearing aids but I'm dependent on eyeglasses. Bifocals in my strong prescription start at $140 from chain "discount" opticians that advertise on TV, around $120 from a couple of local chains that tout themselves as bargain eyeglass purveyors, and cost me less than $40 from an online optical dispensary -- which does NOT charge me extra for 60/40 (far/near vision percentages), while the local opticians do.

Actually, it's Patents

[martin-boundary]

If you break the Patent Fiasco, you will pull the rug from under the medical equipment companies' racket. You will also bring down the drug manufacturing companies' racketeering. Both of those will go a long way towards fixing healthcare.

economies of scale

[Anonymous Coward]

1. Hearing impaired divided by say five major brands will not give anyone economies of scale
2. Hearing aids are medical devices with presumably fda approvals and insurance claims for defective equipment. Unlike consumer electronics.
3. Plus the customers need the devices and simply want them which gives an opportunity for premium pricing.

Related /. story

[aneroid]

Several related things were discussed here: Ask Slashdot: Why Are Hearing Aids So Expensive?; 4 months ago.

Re:Related /. story

[dadioflex]

Shhh, noob. The world has changed a lot since then. We're all living under the ocean, eating meat knitted from hair and powering our kindles with shame.

Royalties

[Roger W Moore]

I'm not sure, perhaps the cost is due to the royalties they have to pay in order to be able to reproduce copyrighted songs.

On a similar note...

[Anonymous Coward]

I visited the show room where I had bought my previous cars. There, a fastidious young man talked about the cars of my preferred brand, Mercedes, and showed me three models. The cheapest started at $50,000. The top-of-the-line model was more than $100,000. I gasped.' A car is basically just an engine in a box so it isn't clear why it costs thousands of dollars while other motorised equipment like microwaves and washing machines have gotten cheaper.

Subsidy

[Roger W Moore]

Smart phones are usually heavily subsidised by the carriers who make their money back via overcharging on the monthly service fee which is why they appear far more affordable than otherwise. However an unlocked iPhone 5 is still half the price of the hearing aid prices quoted and has more features but then it is considerably larger than a hearing aid and the battery does not last as long. So it depends - how much does miniaturisation cost?

Re:Subsidy

[Hadlock]

That may have been true at one point. Unfortunately your reasoning is at least two years out of date. Beyond halo phones, new unsubsidized smart phones can be had for $200 and under now. Smart phones cost less than a new TV, and "bring your own phone" plans are much more popular here in the US now than they were four years ago. Expect the cost of new gingerbread class phones to drop below $100 in the next year. If you don't game on your phone, video, music and text were all perfected on Android back in 2009. That era hardware is so cheap even the cheap Chinese knockoffs are more powerful these days.

affordable

[Anonymous Coward]

RIAA wont make it happen

Start an openaid program ?

[tchiwam]

Gather people who care and get cracking, visual aid, mobility aid, hearing aid etc etc... Include CNC/3D printer plans, BOM and software for all of them. Buy it ready, friend build it or build it yourself...

Individual projects in each field might not be big enough, but a human aid project going from head to toe might have enough co sharing of information and ressources to be viable ?

This is where open hardware can make a difference

[Anonymous Coward]

Would there be a market for an Android based system for this, that offloads the processing to the phone? I am willing to design it and make it open hardware. I will do this based on how many people answer this message and email me. mkb (at) robots-everywhere.com

Open hardware, then?

[spiritplumber]

Would there be a market for an Android based system for this, that offloads the processing to the phone? I am willing to design it and make it open hardware. I will do this based on how many people answer this message and email me. mkb (at) robots-everywhere.com

cheap hearing aids

[Maxo-Texas]

you can buy hearing aids with 10 year old technology on hunting sites for under $100.

It's $745 per month, not $745 per week.

[Anonymous Coward]

Social Security Disability pays $720/month. It's like working 24 hours per week at minimum wage, except that, instead of going to work, you sit on your ass all day bored out of your mind. You can't afford cable television, and you can't go anywhere because you sure as hell can't afford a car (nevermind gas and car insurance) and you only have internet access because you don't have a phone (because the internet is far more useful than a phone). Indeed, you'd probably be starving were it not that your low income means you qualify for food stamps, and you can get a friend to drive you to the store occasionally.

Social Security Disability isn't the luxury everyone thinks it is. Anyone who can do something else with their life, does something else with their life.

Simple: Greed!

[Kiliani]

Short answer: Producing hearing aids is not super cheap, but we are also getting massively overcharged. (So, small lot size production costs may play a role.)

When one of my kids needed aids, our ENT said: "If you know somebody in Hong Kong, or someone who travels there, have them buy the aids for you there. They are produced in Asia, and you can basically buy them at cost. All name brands, all genuine. The companies just mark them up that much when they sell them here."

I looked into it (have an uncle who flies to that area twice a year), and boy, would you be surprised! Markup of the actual devices when coming to Western markets (wholesale) is is around 100%-150%, and when adding services (which means fitting/programming them) 150%-200%, or even more. So, if you buy two digital ones, it may still be cheaper to vacation over there and get them yourself. Or pay up to triple price at home. I just checked - still true.

I wound up not doing that because I could get the service for free - so I got them wholesale (and did not bother my uncle who is a great businessman but rather technophobe - not the person to have buy expensive electronic equipment for you). I am sure my health insurance would not let me do even that, but at that time I had to pay for them myself anyways.

So, that was the advice from a well-connected and well-regarded ENT, and I found it to be true.

In the end: we get fleeced. Simple as that.

Re:You disgust me

[udachny]

Do you realize that for example in case of SS and Medicare, the people who paid the taxes that are supposedly related to those welfare programs were simply paying income taxes, but the early entrants paid almost nothing compared to what they are getting out of those programs, while the later entrants end up paying for the actual benefits of all the early entrants and the current payers (and supposedly those who'll pay in the future) pay much more in all terms, nominal and real, as proportion of their income and as total amounts?

Somebody who paid 30K into Medicare or SS who is now getting those benefits will end up taking out many times (at least 3, but more likely 10 times) the amount they paid?

Do you realize that none of the money that was paid 'into' those programs was invested, there are no funds? There are bonds, but those are not assets, all the money was spent. Every bond has to be sold in order to raise money, but every bond that is sold draws interest and must be bought back.

Thus every dollar that is collected is spent on something else, and then to replace it there is a debt that is created, and just in nominal terms for every dollar that is collected 2 must be paid back in future taxes and in real terms it's much worse than that because of inflation and because the benefits that are paid out are so much bigger than the money that was 'paid in'?

The point is that to have real fair and moral retirement, disability, health care plan a person shouldn't be forced to participate in any government program and instead he should be saving his own money, investing his own money to create his own retirement fund?

Same as with EI, if a person wants to get a pay out in case he is fired, he should be buying private insurance, not be forced to participate in gov't programs. And in order to avoid creating incentives for people to sit on EI until the money train ends, the payout for losing a job from such an insurance product should be done as one payment in bulk.

You have your EI plan and you lost a job after a year or more? You get a check, but only one check, it's a check from insurance, same as would be paid out if you died and had life insurance.

All insurance should be allowed to be insurance and not 'management plans'.

Same with health care and everything else. You are saying that you paid more into SS by age of 26 than others paid over their life times, you are right. If you are a young person you are getting screwed by the old folks.

SS, Medicare, all this stuff is a transfer of wealth from the young and poor people to the old and rich people, the old rich people have their savings, investments and they paid much less proportion of their income (and absolute numbers as well) into those programs over their life times than you would over a decade. By the time somebody who is relatively young and is paying 'into' those programs today gets to collect, he'll collect nothing compared to those, who he paid his entire life.

The ratio of payouts will be reduced, the years you'd have to work will be increased, most importantly the purchasing power of money is destroyed.

The real wages fell since about 1970 by 98% because of inflation, and that's NOT even counting all the increases in taxes.

That's why a high school drop out in 1960s could work at a factory and make enough money to maintain a family without debt, to own a house (and maybe another property) a couple of cars, save for the rainy day and for his kids education, he'd also pay for most of his health care out of pocket and high deductible insurance would be so cheap, that it would be no more than 2 bucks per person per month to cover 2.5 times yearly expenses for hospital stay with the worst health condition.

The government has absolutely annihilated people's productivity and purchasing power with inflation, regulations and taxes.

So, are they better?

[Anonymous Coward]

Are they 4,6609571438493020524332763932967 times better that the ones 20 years ago?

Start your own company

[Anonymous Coward]

If making these things is so cheap and they sell for 2000, it seems like you have a lot of room there. You could start your own company.

This question shows up on slashdot very often, too often, I would say. Either there are many slashdotters with hearing problems who might want to jump in, our you are just trying to create a false sense of interest and potential profit so that somebody else will solve the problem for you.

Exactly: bad insurance, bad regulation

[bradley13]

People complain that for-profit medicine is to blame. This is true, in the sense, that the ground is responsible for hurting you when you trip over your untied shoelaces. I.e., it's true, but it's not the cause.

People with full insurance pay nothing or next to nothing for medical treatment. They do not care how much it costs. Insurance offers such idiotic plans, at least where I live, because the government regulators require them to.

Insurance ought to protect you from catastrophic expenses, not from reasonable expenses that lots of people have. Consider this: Supposed you had to pay all of your health-care expenses up to (say) 5% of your annual income, and 10% of subsequent expenses up to 10% of your annual income. What would the effect be?

1. You would care what ordinary things like hearing aids cost. You would shop around. The companies offering the products would now have to compete for your business. Prices would fall, and fall dramatically.

2. Your insurance costs would sink dramatically. First, because the insurance would rarely have to pay anything. Second, because the free market would be driving medical prices into the basement. For the average person, the saving in insurance costs would more than offset the out-of-pocket medical expenditures.

Government over-regulation is the reason for the current ridiculous prices - and also for the ridiculous bureaucracy in all aspects of medical care. Let the free market actually function in the health-care market, and see what happens.

A last note: it is important that everyone be subject to the rules above. No zero-copays for anyone, no free emergency room visit just because you are on welfare. You have an income, you need treatment, you pay something towards it. This would remove the ridiculous situation of people abusing emergency rooms because it's a way to get free treatment for ordinary things.

Re:Exactly: bad insurance, bad regulation

[Patch86]

Consider this: Supposed you had to pay all of your health-care expenses up to (say) 5% of your annual income, and 10% of subsequent expenses up to 10% of your annual income. What would the effect be?

The effect would be that poor people, for whom 10% of their income is the difference between paying rent AND buying groceries that month, will ration their medication and make themselves ill. The ghettoes will get sicker, differences in life expectancy widen, and the economy gets dragged down. Rich people will continue to buy any medical treatment they like, and the middle classes will continue to follow doctors orders (but will have less money).

In theory, insurers should be lobbying, negotiating and bargaining for lower medical costs to save themselves money. In countries with universal healthcare (e.g., UK with the NHS), the national providers take care of this. The UK has vastly lower medical costs for the same medical treatment compared to the US, and that's because the NHS drives a hard bargain. Patients don't pay a penny.

Re:Exactly: bad insurance, bad regulation

[nbauman]

There is at least 45 years of high-quality research , some of it in randomized controlled trials, on what people do when you give them co-payments. They all come to the same conclusion: People get less unnecessary care, but they also get less necessary care. Co-payments don't even save money. They cost more money in the end.

The first big study was the Rand Health Insurance Experiment on Wikipedia. http://en.wikipedia.org/wiki/RAND_Health_Insurance_Experiment Look it up.

In the last 15 or 20 years, lots of corporate executives believed your argument, and put their employees into plans with copayments. For those corporations that monitored their results, like IBM, the result was always the same: people with chronic diseases didn't follow their regular maintenance, and wound up in the hospital, costing far more money than the plans saved. Those corporations went back to paying the entire bill.

Atul Gawande discussed that recently in the New Yorker. A company found that employees with asthma were less likely to use the (~$1-200/mo ) drugs for controlling asthma, and as a result had exacerbations and wound up in the emergency room (~$1-2,000).

Patients with high blood pressure don't take their BP medications, and wind up with heart attacks, strokes and kidney failure. Patients with rheumatoid arthritis don't take their expensive wonder drugs, and wind up with heart attacks (people with rheumatoid arthritis are more likely to get heart attacks).

When the Medicare managed care companies imposed a $10-20 copay on mammograms, the rate of mammograms dropped by about 15% (according to Trivedi in the New England Journal of Medicine).

One of the things you left out of your calculations is the cost of running a complicated health insurance system, which creates internal free-market incentives (like the Soviet system used to do).

When you pay for health care through insurance companies, as compared to having the government pay for everything directly through taxes, the insurance companies take 15c of your dollar, for profits and administrative expenses. Your doctor gets 85c, and pays 15c of that for managing the insurance company payments, so the doctor is left with 65c of your dollar.

As the Canadians and Brits often tell us, their government-run health care system is so much more efficient than ours, that they pay less in taxes than we do in premiums, and they have no copayments.

One of the problems with your argument is that people can't make informed decisions about their health care. I go into a doctor's office and he tells me he needs to x-ray my knee. What am I going to do -- spend my 15-minute visit having him explain to me why I need an x-ray? Search Google to find out? Shop around for a cheaper x-ray? What if he says, "We have to rule out Paget's disease?" What do I know about Paget's disease? Enough to risk my life? No, I have to take his word for it. (The insurance company paid ~$1,000 for the x-ray.)

The only way to cut out waste in the health care system is not with free-market consumer decisions based on choice, but with medical experts like triage nurses deciding on a case-by-case basis whether I need to see a doctor, and with other doctors reviewing their treatments to make sure they were appropriate. That's how the Canadian and British systems do it successfully.

Re:Exactly: bad insurance, bad regulation

[Reziac]

"People with full insurance pay nothing or next to nothing for medical treatment."

Well, except for the insurance premiums. Most people don't notice the cost because their employer picks up much of the tab (which in turn comes out of their salaries, if only as lower wages than if the cost of an employee wasn't so high), but if you're self-employed... then health insurance can cost you close to $1000 per MONTH for ordinary coverage. Out of your own pocket.

Inaccurate, incomplete, ignorant and naive.

[Anonymous Coward]

The terms are: captive market, closed market, government waste and finally, knowledge imbalance (what's the more adopted term for this? I've been speaking my second and third languages all year, and my English words are accidentally sometimes)

Yes, it is for profit, but a lot of for profit things in an open market end up giving us a pencil.

We didn't get a pencil for cents because of non- selfish self-interest closed market economics.

For profit != expensive. For profit, selfish self-interest systems in an open market can create efficient markets.

So, it could be that they have a high cost, high research or patent overhead that attributes to this, or merely supply/demand of an elastic resource in a fixed market - you can charge what the market will bear - and is that wrong?

Slashdot - don't be the naive-communist idiotic prole masses that is reddit.

* ebay.co.uk

[Rogerborg]

• Search for "hearing aid"
• Prices start at GBP 9.99 delivered from UK stock. For a pair. Or the same items can be ordered direct from China and shipped anywhere in the civilised world.
• Click "Buy it now"

You'll got the Internets in the USA, right?

If you want to pay more for a brand name, pay more, but don't whine that there's no option cheap enough to throw away if it doesn't work.

this is a bit of a shill

[Anonymous Coward]

This is a bit of a shill since they're a client of mine, but here you go: MD Hearing Aid.

yup

[Anonymous Coward]

Yup. Bastids are expensive. And now with the grateful dead lot rushing in, most of them aren't even strong enough anymore. They're those stupid in-ear-canal ones because of delicate sensibilities. I'M TOO YOUNG TO BE WEARING HEARING AIDS. Oh get over it. I've worn 'em since I was three.

I was down to basically ONE choice of hearing aid model that was powerful enough last time. The rest are off catering to other demographics. Dammit.

FYI, hearing aids are *rarely* covered by any health care program. I'll see if that changes with the ACA or not.

Being a program manager for the DoD

[Anonymous Coward]

Actually, it's extremely like defense contracts, but your reason is wrong. We don't throw money around like it's someone else's. However, we live in a regulatory environment that drives up cost and lowers options. We have so much policy and procedure that simple things are very slow, and risk aversion is pandemic, since there is no reward for taking a risk, and your career is terminated if you accept a significant risk that is realized. Therefore, it is beneficial for my career to address a risk by delaying the product, increasing life cycle costs and allowing our warriors downrange to die in the process. The FDA's risk tolerance is so much lower than ours that their process takes longer and costs more. There are two reasons that it takes a billion dollars and 15 years to get a drug to market. One is that we aren't willing to accept the risk of getting it wrong, and the other is that the process is so monstrous that you can't do it cheaper or faster without lying.

Free Markets HA!

[Anonymous Coward]

How about the truth here. The medical people have regulated an industry to the point where you have to be a billionaire in order to enter the market and have effectively staved off the hackers who would have solved this problem years ago. Bluntly a self adjusting hearing aid that adjusts to its user is very possible and could be made for only a few dollars a copy. This isn't rocket science here people and audio codecs are SOP in Software/Firmware. This is LEGO's. The problem here is the complete and utter lack of Free Enterprise. Open this market up!

I wear hearing aids. Due to the lack of competition I have to go to much inconvenience just to buy a micro-stereo Amplifier and the #@#$@%@#$% things are not water proof! Imagine something next to your head with sweat rolling onto it as a regular expected thing and it isn't water proof!!!!

If the USA were to apply to NON-INVASIVE medical devices such as hearing Aids, Head Straps and the like simple safety standards and nothing else, and let the inventors loose on the industry we would have throw away cost levels on hearing aids. They would be as cheap as hand held simple calculators. This is what is wrong with the health care industry people. It needs a dose of freedom!

$2000 for a new car?

[yotto]

I know people who buy hearing aids tend to be older than average, but exactly how old is this person who thinks new cars cost $2000?

I don't even think those crappy 2-seater deathtrap cars from Korea are that cheap.

you are clueless

[doginthewoods]

there is way more to an aid than what tone is loud and what isn't. there is EQ bands, the number and placement of the center points, compression, compression rates, kneepoints, multi band limiters, and compensating for the varying acoustic anomalies that occur, like occlusion, within the ear canal. Jeez, learn what you are talking about before you post.

What's INSIDE a hearing aid?

[Anonymous Coward]

Can somebody post up a breakdown of a hearing aid, so we can marvel at what exactly is inside it, to justify this ridiculous cost? They aren't made of gold, they're tiny, they only amplify sound, how much can they possibly cost to make? We all know on here how little computer chips cost to make.

Because insurance companies

[Gallomimia]

...allow people to afford these prices, there is no supply and demand paradigm that normally keeps most prices decent or at least with some semblance of fairness.

Clarification

[Anonymous Coward]

There is a huge elderly population with loads of spare cash. Old people tend to go deaf. The hearing aid industry is a cartel.

Because...

[WillyWanker]

Anytime there is equipment paired with insurance it's like a license to print money.

$3000 for a CPAP machine? All it does is blow fucking air thru a tube.

Why WON'T Industry Design Affordable Hearing Aids

[Anonymous Coward]

Fixed that for ya

Affordable hearing aids

[Anonymous Coward]

Ok, this is a shameless plug, but that doesn't mean it is the wrong answer. TruHearing is your answer for more affordable hearing aids. First let me just say, I used to work for this company, but have since moved on. They are a great company, and they are working hard and succeeding to bring down the cost of hearing aids. They are honest people and have great customer service. One insurance company had a survey done of their customers, and of all of the suppliers of medical services to the insurance company's customers, TruHearing had the highest customer satisfaction rating. Check them out. You will have to get your employer to enroll in the MemberPlus program www.truhearingmemberplus.com but it is free for your employer to enroll.

Fuck hearing aids...

[Brad1138]

When are we going to be able to repair hearing? We can fix eyes (Obviously they are not at all the same). I am an audiophile who spent 20 years piecing together my dream stereo system. I really love music, for a month or two it brought tears to my eyes, the sound was so beautiful. Then I woke up one morning and everything higher pitch than about vocal range in my left ear was gone and I have tinnitus in the same ear. I can't sit down and listen to music anymore, the ringing and unbalanced hearing destroys stereo imaging and is just plain annoying. Anyway, hearing aids won't help, I hope that before it is too late for me, they are able to repair damage with surgery or something. (Sorry, I know this was a bit off topic).

you are clueless

[Firethorn]

Jeez, read my post, why don't you? The first two steps is simply a rough tuning; detecting those center points. The other stuff you mention is taken care of in stage 3(Clearer audio, not tone) and 4(See a professional; you're unusual).

Phew.

[Thomas Shaddack]

Is any of these requirements something that can not be implemented in an open-source way on e.g. a cheap dsPIC chip? The water-resistance and ESD-robustness are also nothing special; from a water-tight housing, conformal coating and a Li-poly battery to an industry standard ESD protection.

I still don't see the reasons for such high costs.

Even the FDA can be worked around; just sell the thing as something else non-medical and allow an user-end reflashing of the firmware that will add the "regulated" functions.

I can imagine the sound-processing core being sold as a naked board by SparkFun for $30, with printable housings available from Thingiverse and user-customizable with Sugru.

Maybe it's a high time for opensource software and electronics hobbyists to enter the field of health-care technology, and put some squeeze from the Great Distributed Bottom onto the overregulated market. Maybe a HAM-radio club equivalent for hearing aids? There must be a lot of retired engineers with bad hearing, certainly enough to come up with something.

Principles

[Thomas Shaddack]

You will think otherwise once you get older and your so-far presumably fairly perfect health will start deteriorating. Or when some hidden timebomb in your genetic code starts acting up. And before you start babbling about financial responsibility and saving money and so on, mind that you, like everybody else, are just one instance of bad luck away from bankruptcy. Be glad for the welfare safety net under you. You don't know when you will need it; and it is when, not if.

Re:Principles

[shiftless]

Be glad for the welfare safety net under you.

You mean my family?

Re: Principles

[Thomas Shaddack]

That too (but mind that not everybody has one, and not everybody has one able to significantly help when the going gets too tough).

I mean the one that, at least in developed countries, would let you not have to choice between a surgery for your father and education for your children.

Re: Principles

[shiftless]

That too (but mind that not everybody has one, and not everybody has one able to significantly help when the going gets too tough).

Then let a charitable organization help them, or let them die on the streets. I don't give the slightest fuck either way. I can barely keep a roof over my own goddamn head, with the government taking taxes out at every turn to care for all these shitheads who either can't or won't work. Nobody is entitled to eat.

I mean the one that, at least in developed countries, would let you not have to choice between a surgery for your father and education for your children.

At whose expense?

Ear Trumpet workaround

[Thomas Shaddack]

Give the test and autoconfig feature away as a free, preferably open-source, computer software. Give the iphone app the ability to read the presets via QR-code, generated by the PC app. Good luck regulating free software hosted on offshore servers. The commercial apps then can retain the functionality by splitting off the regulated functions away to the unregulatable noncommercial offshore platforms.

Hearing aids are custom made by hand.

[DaveV1.0]

Hearing aids are made by hand with a perfect fit and practically invisible. Things that are custom made by hand generally cost a lot of money. If you don't mind a hearing aid that can be seen and a crappy fit, buy a $19.99 hearing aid

What that you say?

[crovira]

If everyone paid, or worse, if we got the average designer, we'd probably get bulky devices that look like something out of Terry Gilliam's Brazil.

I wonder what Johnny Ives would design?

I bet it would be something that looks remarkably like the latest Apple earphones, with some external reception membranes, a built-in battery and 20-20kHz amplifiers and a pair of sound production membranes. (It would also be remote tailorable/controllable via your Mac, iPhone, iPad, iPod Touch.)

Price $129.00 a pair.

Two words - Government Regulation

[buybuydandavis]

Hearing aids that are regulated as medical devices are expensive. Electronic gizmos that help you hear are a tenth the cost. Search for "cheap hearing aids".

Of course they could be cheaper and better without the FDA enabling corporate rent seeking. Same with medical care. Same with medicine. Government regulations give the government power, and corporations money. That's what they're there for.

Re:three words, one hyphen: FASCIST markets

[Anonymous Coward]

It's both discouraging and ominous for the country that we had to get THIS far down the thread of supposedly intelligent and educated comments before someone clearly pointed out that WE DON'T HAVE FREE MARKETS IN THE UNITED STATES. By definition, you can't have free markets if players aren't free to do what they would do in the absence of force, collusion, manipulation, and interference. When supposed competitors actually collude to fix prices and forcibly keep other competitors from emerging you certainly don't have free markets. But, also, you also can't have free markets when the government reduces freedom (the definition of govern is to reduce freedom by the way; that is what a 'governor' does in a mechanical system) to freely compete in buying and selling. Nor can you have free markets when the government (the 500 pound gorilla with a monopoly on 'legal' force) perturbs free choice in ANY way. And when the government SYSTEMATICALLY perturbs free choice, in pretty much every way, to favor certain players (pretty much all a government does, by the way, fairy tales aside) you not only don't have free markets you have FASCIST markets.

Re:three words, one hyphen: FASCIST markets

[Anonymous Coward]

By the way: "monetary policy" and "tax policy" and pretty much all government "policies" are all GROSSLY destructive of free markets and are levers to favor the politically connected -- that is, the Fascists. When SOME people (banks and hedgies and corporations) can borrow at effectively zero percent directly from the government while other people are forced to pay vigorish, you don't have free markets. When SOME people (e.g., rMoney) pay capital gains rates of 15% on ordinary income (hedge fund managers bribed the government to get their ordinary income taxed at capital gains rates even though they don't have any of their own money invested so their gains can't -- by definition -- be considered capital gains) you don't have free markets. When SOME people can get government loans and freebies (e.g. Obamanation) while others don't get the same treatment, you don't have free markets.

People don't make nearly the same decisions when interest rates are near zero percent as they do when they are at, say, ten percent. And when governments print money from thin air, and hand it out preferentially to their buddies, you don't have free markets.

We don't live in "Land of the free and home of the brave" and we aren't in Kansas any more.

Rotary International

[Anonymous Coward]

The Rotary International club that I belong to bought 100 hearing aids from a company in Africa for less than US$100 each and donated them to some children in Mexico about two years ago. The best part is that the hearing aid battery can be recharged through a solar power generator that was included with the device at no extra charge. Most of the children who received them live in villages without electricity. Unfortunately, they are not licensed for sale in the U.S.

The joy on the faces of the children after hearing for the first time brought tears to our eyes.

Hearing aids

[krid4]

From the Netherlands: Hearing aids factory costs are around Euro 20 to 50. For normal hearing loss, due to aging, try this link http://babble.nl/ . Their cheapest, 'in your ear' model is E. 90,--. An advances model, (i looking at the prototype, don't know if it is already available) costs E. 190. Prices per ear.

Brazillian, low cost, Manaus hearing aid

[Anonymous Coward]

There's a story from 2010 that scientists of USP(University of São Paulo) have developed a low cost hearing aid, called Manaus. I could not find where to buy it and I think they probably not mass producing it yet, because of patent problems.

Here's the story: http://translate.google.com.br/translate?sl=pt&tl=en&js=n&prev=_t&hl=pt-BR&ie=UTF-8&layout=2&eotf=1&u=http%3A%2F%2Feconomia.ig.com.br%2Fempresas%2Fcientistas-da-usp-criam-aparelho-auditivo-generico%2Fn1237557024393.html

Startups that disrupt the hearing aid market

[leehanxue]

Good news is we have startups such as http://www.embracehearing.com/ that sell sub-$1,000 hearing aids.

Is it commonly covered?

[lordbah]

My health insurance (MVP) covers exactly nothing for hearing aids (it would if I was under age 18, i.e. 30 years ago when I didn't need them). Can I still blame the insurance companies? Is it a common benefit?

(They don't cover eyeglasses either)

Trivial reason: FDA approval costs

[Anonymous Coward]

A hearing aid is a "medical device" covered by FDA approvals. The cost of going through FDA is comparable to what it costs to source nuclear weapons in terms of paper work, testing and materials tracing. You simply don't have enough people needing hearing aids to amortize that cost AND allow for a profit.

If you want cheap: go overseas where regulations are less onerous and buy there. E.g. China, Taiwan, Thailand or India. Yes, there is more of a chance the device won't be as effective or as tiny but it WILL be cheaper.

Re:You disgust me

[shiftless]

You can hate your fellow man all you like, but your hate will never change anything. Might as well slice the head off of a hydra as kill a welfare recipient. The money you "save" by doing so will simply be redirected to some other form of welfare.

Is that an argument against me, or an argument in support of warfare?

Just buy some off ebay

[oernii]

Spend 200-300 dollars on 15 different ebay aids and test them. Publish the result and if you find a good one, many people will thatnk you.