People like to say Washington is broken. But sometimes policymakers on opposite sides of the ideological spectrum can find common ground and reach an agreement that not only satisfies their goals but gets something important done for the American people. And then the businesses whose profits might be imperiled by such progress get to work. It’s not that Washington is broken, then, so much as there are lots of people interested in breaking it.
The latest instance involves a bipartisan bill released the day before last year’s election, authored by Sens. Chuck Grassley (R-IA) and Elizabeth Warren (D-MA). The bill would simply make lower-level hearing aids available over the counter.
Hearing aids are quite an amazing technology when you think of it — a device that returns the gift of sound to the auditorily impaired. But unlike eyeglasses or contact lenses that require only a prescription, to get a hearing aid you need a professional evaluation, a fitting and then follow-up appointments with audiologists to properly adjust the device. And you pay for all that up front.
A presidential-level advisory panel in 2015 reported that the average price of a hearing aid is $2,363 per ear, so nearly $5,000 for the typical patient. The component parts of the device cost around $100. And most insurance coverage, including Medicare, doesn’t cover hearing, meaning the costs are all borne by the individual.
Given these facts, it’s no wonder only 14 percent of the 30 million Americans who need hearing assistance use the technology; the rest can’t afford it. So the Grassley/Warren bill set out to solve the problem, a novel idea in Congress these days. It would allow anyone to buy hearing aids that compensate for moderate to mild auditory loss over the counter (OTC) without an evaluation, much like basic reading glasses. The Food and Drug Administration would need to issue labeling and safety standards for this category, as with any OTC medical device.
The general idea is to allow millions more Americans to access hearing aids. Plus, the prospect of new customers could spur competition and drive down prices. Today, after numerous mergers, just six companies (William Demant, GN Store Nord, Sonova and Amplifon are the biggest) control the market, offering little incentive to lower prices. Oligopolies are a fixture in health care, from prescription drugs to hospitals to dialysis centers, and rolling back one could build momentum to truly reform health care delivery systems.
Not only did Warren and Grassley introduce the bill, they got it into a must-pass piece of legislation to reauthorize user fees for the FDA. That bill is likely to become law by the end of July. So a problem caused by a government-granted monopoly looks like it’ll actually get solved. Or it did, until conservatives found the name “Elizabeth Warren” atop the bill.
Out of nowhere, Frontiers of Freedom and 19 other right-wing groups got incredibly exercised about hearing aids, calling the Warren-Grassley bill (while conveniently omitting Grassley’s name) “just another big government ploy to create more regulations and aid corporate rent seekers.”
They claim that creating an OTC market for hearing aids would impact the market for personal sound amplification products, or PSAPs. These consumer electronics amplify sound but aren’t strong enough for people with hearing loss. They’re marketed for bird watchers, or snoopers, or so hunters can hear the slightest rustling in the woods (how sporting!). So you know what comes next, right? The Gun Owners of America, a group that’s improbably to the right of the NRA, has come out against the bill, claiming that an effort to assist the hearing impaired is somehow part of a massive scheme to upend the Second Amendment.
Let’s be clear that the Warren-Grassley bill wouldn’t do anything to the rules for PSAPs. The FDA has already created guidance on the sale of PSAPs, and the bill merely requires the agency to update it, distinguishing which products qualify as OTC hearing aids for combating hearing loss and which qualify as PSAPs. The same cheap PSAPs will be available for sale for hunters or anyone else, while lower-cost products that can fix hearing loss would be available too without a prescription. As Grassley told the Boston Globe, “PSAPs do not go through a medical device evaluation… the bill doesn’t change that.”
This hasn’t settled the hysteria from a series of suspiciously timed op-eds, warning of… well, something bad. They don’t really have the talking points down. One thinks Warren-Grassley would ruin the important work of specialists who customize hearing aids, an argument you’d expect from a front for industry incumbents. But another claims that PSAPs already work well as low-end alternatives, and “regulating” them (i.e., distinguishing them from a new class of OTC hearing aids) will drive them out of the market. So are the incumbent hearing aid companies threatened, or the PSAPs?
Or will this just harm veterans, as a third op-ed argues? (I don’t know how, because veterans’ TRICARE actually covers hearing aids, so there wouldn’t be any change). Or is it a sop to the technology industry, companies like Doppler Labs or Bose who want to market OTC hearing aid products?
This type of throw-everything-at-the-wall, see-what-sticks flurry happens when an interest group sounds the alarm that its protected profits might be at risk. In this case, it’s the big six hearing aid companies and the audiologists who benefit from all hearing assistance routing through them. But another interest group is driving opposition: those who want to prevent Elizabeth Warren from notching an accomplishment in a Congress led by the opposing party. Regardless of who the legislation might help, they just cannot stomach an effective senator who may have designs on higher office.
It’ll be difficult for the tumult to derail the hearing aid reform now that it has been placed into the FDA user fee bill. Inertia alone suggests that millions of Americans with hearing loss will get better access to assistance within the three-year time frame of the legislation. But if the far right does succeed in stirring enough controversy to prevent this outcome, out of spite for a senator they don’t like, that deserves to be widely publicized. We know that winning and losing politically takes precedence in Washington over actual policies that help people. I hope this hearing aid brouhaha doesn’t prove it again.