on this silly site [slashdot.org]

They need to be able to have FDA testing, certification, independent verification of testing, quality assurance and all the paperwork hell -that- involves. The certification needs certifiers to certify that the certification has certificates on the certifiers to do certifications and so on... There is a MASSIVE paperwork rats-nest involved in making ANYTHING that used in healthcare.

It's why healthcare spending is rapidly outstripping the US economy, to be completely honest.

As "medical devices" hearing aids must by law be sold by licensed audiologists, and those same audiologists' trade organization lobbies governments at every level to keep up a very tight monopoly control of the marketplace.

I think you miss the point. When Joe Sixpack doesn't have to pay for Product X, he doesn't care whether Product X costs $10 or $10,000,000.

Health insurers pass the cost on to employers, who have to keep paying the increased premiums to keep their employees happy. If Joe Sixpack had to pay for their own health insurance, then he would object when they doubled the premiums to cover those $10,000,000 products that could have been bought in a free market for $10.

Am I the only one that read this as two completely contradicting statements? Surely, you must see the logic that if there are people forced into paying out of pocket to hear, that there is some market pressure to make lower priced hearing aids!

I take a medication daily. With my insurance it costs me $45 a month, a generic version recently came out, it costs me $45 a month, if I want the non-generic it will cost me @$400

The insurance companies have ways of pushing you to the cheaper option if a cheaper option is available, mainly by not covering the more expensive option.

Don't worry, this topic deserves about three more submissions before even Slashdot deems it not worthy of a repeat.

The electronics must be small, they mustn't be very heavy, and the must do something that is computationally expensive (signal isolation in a noisy background), combined with amplification, all in a custom fitting (to your ear) enclosure.

On the other hand, you have people stating that a mass marketed device which is identical for a run of over 11 million last quarter, with ability to use bigger (lower cost) components, bought in bulk (by the millions) is cheap, so this custom device should be too.

Basically they are expensive for all the reasons the article poster is ignoring, which reduces the article to "I want one cheaper, waahhhhaaahhh!!!"

For pretty much the same reason that a small piece of soft foam as a filter for my CPAP -- not magic foam made from unicorn testicles, just bog-standard foam, about 2" square -- is billed to my insurance company at 25.00.(Seriously, due to a paperwork snafu, at one point, I got the itemized bill instead of my insurance company getting it, and it's ridiculous what they charge.) Because they can. (My insurance company, I'm sure, just laughs and pays them a buck, at most, but having the item be "worth" 25.00 is probably a lot of use to accountants at every stage in the transaction.)

Why did a simple ultrasound of my heart, performed by a technician who was not a doctor, not a nurse, just someone who'd completed "Be an ultrasound technician!" at night school, and which took about 15 minutes, cost over $1000.00? No reason. It's a random number. They bill the insurance company, or the government, depending on if you have private health insurance or medicare/medicaid, and then the people they bill pay whatever amount THEY decide to pay for an ultrasound. This doesn't work, of course, if the hospital has to bill YOU -- you have to pay what they ask. Sucks to be you. Or me, when I didn't have insurance.

It's because there's no market control; there's no shopping around; there's no way anyone can (legally) just start making hearing aids and having them sold at Wal-Mart. If eyeglasses followed the same rules, you couldn't buy even a pair of reading glasses without going to a licensed optometrist and paying 250.00, minimum. As it is, I can go to the aforementioned Wal-Mart and try on a few quickly, then pick whatever I like best and walk out having paid less than I'd pay to go to the movies.

If I were going to wear a sound amplifier in my ear all day every day, I'd like some assurance that it's been tested and that it isn't outputting such high sound levels that it's killing off whatever amount of hearing I have left.

Just because it's not implanted inside the body doesn't mean that it can't cause harm.

My hearing aids were covered by my father's insurance (he works for the state, so great insurance) until I turned 21. Now I'm trying to figure out how to pay for my next pair because none of my employers since then have even had partial coverage for hearing aids. It's one of the frustrating gaps in most employer-offered insurances. My current pair were $4000, which includes cleaning every six months (not sure for how many years).

I will say that hearing aid technology has improved at an impressive rate over the past 19 years that I've been wearing them, and costs of a low to mid-end hearing aid is about the same as it was in 1994 when I got my first pair, but inflation has gone up quite a bit since then - not to mention they're more comfortable and durable than ever.

Not as long as they're a minority. And even then - think about it this way - if you have a 100 patients needing one and only half have insurance... would you still rather sell 50 hearing aids at $3,000 each or 100 at $500 each? Plus it's not like some startup can easily flood the market with cheap alternatives either - hearing aids are Class I regulated medical devices... I can only imagine the amount of bureaucracy that must be involved to obtaining that classification.

No. No, it doesn't. My sister is hearing impaired and we can find exactly *no* insurance plans that would cover hearing aids for her type of hearing loss. We found ONE plan that would cover hearing aids, but only if the child was under nine and the hearing loss was caused by leukemia.

Consider this in the healthcare debate, because of the hearing aids that we were luckily able to save up and afford, my sister was able to only attend a few years of special ed and then was able to mainstream into a normal classroom, largely because the hearing aids allowed her to not have to learn sign language. This potentially saved the public school district a ton of money. It also saved the government a ton of money as she is now in college (to become an audiologist) instead of on disability.

Well, not exactly a supply and demand issue, unless you are talking about the supply of Funds available.

As soon as you can get a tablet or cell phone covered by medical insurance the price of those items will
go thru the roof as well.

In some markets, the price of goods expands to absorb the available funds, especially when artificial
barriers to entry keep competition to a minimum.

Don't be a retard. There's nothing Randian about pointing out the effect that big insurance companies have on the market for medical devices. If people had to buy these things out of pocket exclusively, the economics would be totally different, and that's true regardless of your political outlook. As someone else here pointed out with airline tickets bought by business travelers, when people aren't spending their own money (and instead, spending their employer's or health insurance company's), they don't bother to count pennies like they do when they're spending out of their own bank account, even though the cumulative effect does affect them later on (through higher insurance premiums, lower salaries, etc.).

Gad-damn but you must be a sad, hateful little creature. Microwave? Really? I guess to assholes like this, you're not "poor" unless you're cooking your dinner over a trash fire while living in a box under the overpass.

That's called being homeless, not poor, fuckhead, and having been both, I'm quite comfortable in telling you that you obviously have never had to deal with any actual hardship in your life, and therefore are talking out of your ass.

Or housing. Flood the market with cheap financing and a governement directive to put everyone into a mortaged home and prices went on a moonshot. Right up until they didn't.

Just like the other reply already mentioned, college tuition and low interest government loans are again creating a moonshot effect.

And you are almost certainly correct on the same effect causing hearing aids coverable by insurance/medicare/etc. to be priced like nobody actually has to pay... because if you are asking the price you are paying for it yourself and realize that if you have to ask, you can't afford it.

Happens every time but we fall for the same trick over and over. Intelligence seems to be in short supply.

Oddly enough, that joke is actually relevant. There are really two different types of hearing aids:
1. Volume-based hearing aids which are so cheap now that they're sold for $10 on chinese websites, and you could build one yourself for less than $3 worth of parts.
2. Frequency adjust hearing aids- these are actually tiny computers that slightly shift the frequency of the waveform for people who have frequency-specific hearing disorders. The cost for them is about $500 base, plus a couple of weeks of software engineering to tune them to the INDIVIDUAL User. It is the second type that the original author's mother needs, and yes, in a way it is a supply and demand problem as *each unit* (even in a pair) has to be tuned to the disability of the individual ear.

So is the cheapest non-smart cellphone on the market, or your $100 noise-cancelling headphones... and although the market isn't as large, we're still talking about something that almost everybody will need as their bodies pass their sell-by date.

...and if you're actually paying for the Audiologist's time rather than the hardware (the most reasonable explanation of the price) maybe that should be made a bit more transparent.

Methinks its partly a hangover from the days when hearing aids were at the bleeding edge of miniaturised electronics.

At this point the audiologist isn't much different than the eye doctor. If you go in the military you aren't given a vision test manually, you look into a machine and it flips lens over your eyes while you focus on a spot and the machine can tell whether you are properly focused or not and determines your prescription automatically. The hearing tests can be mostly automated, it can't look at your purpil to objectively determine focus but it can play sounds and have you press a button and determine if you pressed at the right times just as well as a doctor can. After the exam determines your hearing capabilities software programs a hearing aid or pair of them. You could replace the doctor with a booth at W@lmart like they have for foot pads now and it would be good enough for most.

They already have hearing aids comparable to what was available 5-10yrs ago freely available for $50-300 sold as hunting enhancements. They are better than nothing. So obviously you don't have to get FDA clearance for a hearing device, you just need it if you want the cost to be paid by insurance. They aren't individually fit but they have electronics with a universal fit and then a set of rubber pieces to go in the ear. You just pick whichever is most comfortable. It's an electronics device, the cost to make a better one is a one off price and the price per unit is negligible after that. The same with the rubber pieces.

Granted that is for normal hearing aids. If you are completely dear in one ear or something exotic that is a different story.

Prior to the mid 80s, not everyone had a microwave, and yet everyone survived. That means a microwave is a luxury item. As is a TV, as is cable, as is a cell phone. I grew up w/o any of these, and we were poor, as in, not every night is necessarily a dinner night. You can be poor w/o being homeless, all it takes is just enough money to pay rent.

> You can't blame the government for these scandals when it is the banks...

Yes I can. Because I know who drove those policies. Freddie and Fannie along with Congress and Presidents from Carter to Bush II. The insane push for 'affordable housing' and the idea that renting == bad, mortgage == good. They looked at stats that showed homeowners to have several socially desirable qualities and confused cause and effect in an epic fail for the ages.

The banks were in a no-win scenario so they cheated.

The government was demanding they make an ever growing percentage of their loans to politically preferred customers regardless of ability to repay. But it was ok because if you just made sure they could probably pay for the first year you could push the paper off on Freddie or Fannie and it was all going to be good. Because otherwise the banks wouldn't have done something that stupid regardless of how much political and regulatory pressure was applied to them. But then Freddie and Fannie had to do something with all that dodgy paper and so did the banking industry. Hmm, what to do, what to do. Mortgage backed securities! Except most people started figuring out the game of hot potatoe (nod to Quayle..) going on and started hedging those with derivatives thinking they were so clever. But when it ALL goes boom at once there ain't nobody can collect on those contracts because everybody gets boned at the same time. Short version, things that can't go on forever don't.

2. Frequency adjust hearing aids- these are actually tiny computers that slightly shift the frequency of the waveform for people who have frequency-specific hearing disorders. The cost for them is about $500 base, plus a couple of weeks of software engineering to tune them to the INDIVIDUAL User. It is the second type that the original author's mother needs, and yes, in a way it is a supply and demand problem as *each unit* (even in a pair) has to be tuned to the disability of the individual ear.

Bogus argument

We have these cool things called "algorithms" and "parameters" which we implement in these things called "computers". A generic hearing aid could easily be made and the customer could sit in an automated booth at wallmart, listen to some automated test sounds, give feedback to the booth computer and the booth computer could tweak the parameters for an individual hearing aid, flash the parameters, and provide the "custom" hearing aids for the user to checkout. If you REALLY wanted to get exotic and custom, you could have the booth tell the user to put-in the new aid, re-test, and tweak the values and re-flash the parameters before sending him/her to the checkout. This is the sort of innovation that would have appeared years ago if hearing aids had never been classed as "medical devices". This is like the guys who supply a bunch of uber-expensive "medical equipment" to docs and hospitals trying to explain why they charge so much for a slow two-trace oscilliscope with a different label on the face and some slightly different firmware...

Replying to myself.... Got distracted and hit submit, Forgetting to explicitly tie what I wrote to your chief complaint and I know that if I don't no prog has the reasoning skills to make the leap. (by definition, otherwise they wouldn't be a prog anymore)

> Except people were encouraged to take out second mortgages to pay off their bills, take trips, do some property improvement.

That was a obvious side effect of the policies I noted above. Ram a huge influx of new demand into the housing market and prices shoot up. Combine with the Fed pushing interest rates far below market in a different case of the goverment meddling and you get what happened. Home values didn't just go up, it was a moonshot, cash out refi very attractive and banks more than willing to write the paper and hand it off, making their money off the up front fees. And if thought they were a bit too willing to take risks when they only suspected they were 'too big to fail' just wait, now it is written into law.

Some of us knew better. I'm not underwater. In fact I'm not even mortgaged anymore.

> When a bank approves 40 applications without looking at what their
> financial situation is or their income, that is a huge problem.

Yes it is. Now be bold enough to ask the right question. Why would they do something that dumb? Answer: It wasn't dumb because they got the fees up front and the taxpayers (through Freddie/Fannie) got the bill. They were playing the game by the rules Congress wrote.

> College tuition isn't going up because of easy loans, most states have raised tuition due to the financial crisis.

And why did they do that? Because they can. Because pretty much anyone qualifies for low interest loans underwritten by the Federal Government. Tuition has been going up faster than inflation for generations. Just like healthcare. Both for the same reason. Before the big crunch tuition was so insane the taxpayers were kicking in along with the grants and loans. But where the money comes from doesn't change the fact that the number of dollars per pupil being spent is going up, up and up. Because it can.

Until you realize that many insurance programs don't cover hearing aids or have severe caps on them. However, more to your point, as you are probably aware, health insurance was provided by employers during WWII because of wage freezes. Employer provided health insurance was a way to increase the benefit to the employee for working at said company. However, it is important to remember that it was in lieu of increasing wages.

Jump ahead 60+ years. If Joe Sixpack suddenly had to provide his own insurance instead of his employer, what makes you think that wages won't increase correspondingly to cover the cost. Whether Joe Sixpack is paid 100% in cash or 80% in cash and 20% in other benefits, the cost to the company is the same. We see this all the time. When housing, fuel, food and other things that effect the cost of living, wages have to increase. If the employer paid portion of health insurance is suddenly passed on to the employee, then likewise, wages will have to increase. Furthermore, as the 100% employee paid premiums increase, wages will still have to increase. One way or another, it will cost the employer the same amount. Most likely it will cost more, because skilled labor will migrate to those companies that show better care and working conditions for their employees. Then the worker productivity at the original company will decline and overall profit margins decrease.

Face it. If a business is paying a worker $30,000 in wages and $8,000 for the employer share of health insurance, they are effectively paying $38,000 for that position. Cutting out health insurance will just mean that they end up paying $38,000 in wages, unless they really think they will be able to get workers for the equivalent of paying them 17% less than the do now.

I'm not so sure.

Just looking at round bald numbers from the ten year interval of 1999 to 2009 you can see that Student Tuition at Central Michigan has grown 2.6 times, while the total budget has only grown 1.7 times. And state funding has held steady over those years.

Bottom line Figures for 1999 [cmich.edu] show Tuition totaling $79,762,133.
Bottom Line Figures for 2009 [cmich.edu] show Tuition totaling $214,308,670
Tuition grew to 2.6 times the 1999 values.

State Funding was $79,796,415 in 1999 and $80,064,200 in 2009, a virtual wash.
Total revenue was $227,472,170 in 1999 and $397,036,721 in 2009 or 1.7 times.

This is without regard to the total number of students, but the fact that Tuition increase of 2.6 times matches so closely the Cost Per Credit hour growth of 2.6
would suggest that the enrollment was not dramatically higher, and this is born out Here [cmich.edu] where 2002 undergrad enrollment was 17k, and 2011 enrollment was 19k.

(Total compensation (wages) increased by 1.6 times over that interval. It seems the revenue isn't all flowing into faculty pockets)

So Without becoming a CPA, and chasing every penny, its clear that the student out of pocket expenses have grown at a rate vastly higher than the University budget as a whole. The vast majority of the expansion in the budget is from tuition.

The cost of the of a college education has expanded to absorb the available student loan money.

But it does mean more expensive.

Yes, the chart of sensitivity versus frequency can be fully automatic, but it is usually done manually so the fee can be maxed. I would like to see a machine, like blood pressure in Walmart where you wear headphones and respond to various sounds at various frequencies at lower and lower intensities until they have mapped your profile. It should take 2 minutes or so, depending on the number of data points wanted, with more data = more time = better profile.
Like the BP machines, the next step is to a doctor, but with hearing profile chart from the machine. you would be able to send that profile to a number of makers and get quotes. Since this is fully external, it should be OK, but some specialists will fight tooth and nail to "protect the public" to outlaw it. In 1950 most highrises had an elevator operator, you entered, told him your floor, and he pushed that button for you. There were endless strikes by the elevator operators union who said thousands would die (LOL) unless we keep our jobs and by the way, we want more $$. Same with the projectionists union. http://tinyurl.com/dx5wcoo [tinyurl.com]
  Those oxes gored make the loudest bellowing, and these audiology doctor oxes have lobby groups.