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The sector I just described actually exists. It is the business of manufacturing, prescribing, and fitting hearing aids. Judged by the standard of making sure people who need the help get it, the sector is doing a terrible job. According to researchers, 80 percent of adults between the ages of fifty-five and seventy-four who might benefit from a hearing aid don't have one,and many who do have one don't use it. Anyone who has ever tried to persuade an older person whom they care about to get help with their hearing (and who hasn't?) is all too familiar with the negative aspects of how this corner of the healthcare market is organized.

For starters, hearing aids are expensive. In 2017, the New York Times reported prices ranging from $1,500 to $2,000 or more per ear. Medicare does not cover hearing aids. Barbara Kelley, executive director of the Hearing Loss Association of America, reports that "the number one complaint we get in phone calls every day is, I need help, I can't afford hearing aids."

But that isn't the only problem. The traditional hearing aid business is regulated by the US Food and Drug Administration (FDA), and access to the technology is tightly controlled by incumbents. Audiologists, their lobbying associations, and the few (six—actually, soon to be five) companies that manufacture hearing aids have strictly limited the options available to patients. The incumbents insist that what all patients want is the "gold standard." As one observer described it, this involves buying a hearing aid only after a thorough diagnostic evaluation that includes otoscopy and bone conduction testing, speech-in-noise testing, real-ear measurement/speech mapping, aural rehabilitation, and hands-on hearing aid fitting. Even if they have the means, for many people this seems like overkill.

Finally, we have the social stigma factor. People don't want to wear aids for fear of looking "old." Despite strong evidence that they could use the audible help, admitting it is tough. The often ugly, obvious, and occasionally noisy traditional hearing aids are whatever is the opposite of cool.

I know this firsthand. When I asked my mother-in-law about a whistling noise I heard at a family gathering, I didn't realize that she had finally started to use her hearing aid and that it was the source of the unfamiliar noise. She yanked it out of her ear, stuck it back in a drawer, and didn't use it for the rest of our visit. Sadly for her (and distressingly for me), the benefit of using an aid to fully participate in the conversations she craved was no match for the "embarrassment" of wearing the device. Had I only known that this was a common feature of hearing aids, I would have kept my mouth shut!

This is serious stuff. A study by Frank Lin of Johns Hopkins found that hearing loss is associated with an increased risk of developing dementia, of social isolation, and even of an increased risk of falling. Uncorrected hearing loss makes it even harder for eventual treatment to be successful and increases the cognitive load on the brains of people struggling to make out what others are saying. Clearly, this is a social and health problem of epidemic proportions.

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