Ask Slashdot: Why Are Hearing Aids So Expensive? 629
solune writes "You can get a tablet these days for a few hundred dollars, and laptops for a few hundred more. Gaming consoles, TVs, and smartphones are all available for under a thousand bucks. Yet, a decent hearing aid for my mom will go upwards of $3000! With ever-shrinking electronic components, better capabilities, and technological advancements, not to mention the rapidly increasing potential user base, I would think quality hearing aids should be coming in a lot cheaper than what we can find. Adding fuel to my fire is that a hearing aid will greatly improve my mom's life — not to mention the lives of millions of others out there. Currently, she suffers from frustration and isolation with having to ask people to 'speak up', and nodding her head to things her kids and grandkids say. We've tried the cheapies, and they're fraught with problems. So, can someone tell me why a hearing aid should be so expensive?"
Because insurance pays for them (Score:4, Informative)
'nuff said
Re:Because insurance pays for them (Score:4, Informative)
Yep. No market pressures to lower the price. Sucks if you don't have or can't get insurance.
Regulated medical device (Score:5, Insightful)
Yep. No market pressures to lower the price. Sucks if you don't have or can't get insurance.
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!
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.
Re:Regulated medical device (Score:5, Informative)
I see them now too, that hook up with bluetooth to ones cell phone to make talking on those easier.
There's quite a bit of high tech audio processing in these things...and with the research and all, and lets face it...proprietary, patented algorithms and the like....it isn't cheap to make a quality hearing aid these days. They're packing a lot more than just amplification in these tiny units.
One important step is...get with a GOOD audiologist that you can work with...for testing and picking out the ones with the features that work best for you or those that need them.
Re:Regulated medical device (Score:5, Interesting)
Re:Regulated medical device (Score:5, Informative)
If a persons hearing in each ear is charted, frequency versus sensitivity you fine a lot of variation in people with hearing loss at various frequencies caused by various legal and not legal drugs, loud music, impulse noise from Guns of jets etc. The hearing aid is then programmed to boost/cut various frequencies to get as close as possible to the natural ear with no deficiencies. They have built in equalization. The better the resolution of this equalization and the better the job the audiologists do and the better hearing aid purchased = best results. The hearing aid itself has a base cost of about $50, plus fees to program each one, test with the person in a quiet room, fit to the ear drum shape etc, all adds cost. Low power, more efficient units cost more = last longer on smaller battery
That said, there are many ripoffs out there, and many locked up distribution channels by people who want to sell a $50 item for $2000. Hearing loss forums can help, but they get a lot of manufacturers shills in there, takes a while to know the crooks.
Re:Regulated medical device (Score:5, Informative)
Programs like MATLAB can calculate the necessary coefficients on the fly. Any skilled engineer can write a program to convert a given frequency and phase characteristics to a list of filter coefficients. Even if you want to do fancy things like lattice filters it's still not very complicated as most of these are designed by converting the direct form of the filter using a recursive algorithm. Again something a computer can do.
The actual cost I'd say comes from the size of the hardware combined with a good battery. If you wish to miniaturize it'll cost you big time. And quantities in the hundreds of thousands aren't quite enough to warrant the cost of miniaturization as these sort of things will take some custom hardware. Mask fabrication and set-up costs for a run of wafers; well it isn't cheap.
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Dolby labs has been successfully marketing simple patented filter profiles for decades, it's like the secret formula for Coca Cola - there's nothing to the R&D, everything in the marketing.
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Re:Regulated medical device (Score:5, Informative)
Familiar with duplexer tuning, however a hearing aid is mono-directional, and as solidraven (1633185) says, determining the gain versus frequency profile should be quick. Frequencies that have gone fully deaf - no cochlear hairs left, will probably not be compensatable with an external device, we can directly stimulate the nerves with a cochlear implant, after which the person learns to hear anew. Here is a simple youtube about it http://www.youtube.com/watch?v=SmNpP2fr57A [youtube.com], the comments are also of interest. This search is also useful http://tinyurl.com/cq8bz3w [tinyurl.com].
It is my understanding that you can buy the programmable chip that is a complete processor heart of a hearing aid from many makers. Here is another search on that topic.
http://tinyurl.com/cwcuwuq [tinyurl.com].
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That's funny, I could swear my hearing aid picks up sound in more than one direction. I can hear in front of me, behind me, to the side, not as much from the other side, as my thick skull and wet brain seem to do a handy job of blocking and absorbing sound from that direction. A hearing aid microphone might point mono-directionally, but is definitely not mono-directional.
It can also have numerous stored filters, easily switchable. Furthermore frequencies that have gone deaf can sometimes be compensated fo
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The setting of the hearing aid's transfer function, or even a set of transfer functions if they should vary with sound level, is not hard at all. This is all well known digital signal processing, nothing inherently costly or complex about it.
Re:Regulated medical device (Score:4, Insightful)
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.
Re:Regulated medical device (Score:5, Insightful)
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.
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Re:Regulated medical device (Score:5, Insightful)
Patented does not mean better.
But it does mean more expensive.
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I'm inclined to agree. Face it, if they had some super incredible sound processing algorithms, they'd be raking in the money licensing them to other companies for other uses and we'd hear about it somewhere. Sadly, that somewhere would probably be a patent lawsuit.
Re:Regulated medical device (Score:5, Interesting)
In the old days, they'd make 'em with cheap components with 5% or more resistance / capacitance variation, then test them when they came off the line and sort them into bins for "prescription" filter characteristics.
Re:Regulated medical device (Score:5, Insightful)
That, and today's hearing aids don't just simply amplify external sound. They are filled with a great deal of very sophisticated audio analysis, and digital sound processing...
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.
Re:Regulated medical device (Score:5, Informative)
- hearing aids are Class I regulated medical devices... I can only imagine the amount of bureaucracy that must be involved to obtaining that classification.
That's pretty much the only thing you've said that matters. Well that and the fact that most of them are at least partially customized to the patient. Unlike some products which are significantly cheaper in canada because of collective bargaining and our healthcare system refusing to waste money on billing the way the US does, hearing aids are about the same here.
To sell any medical device it goes through layers of scrutiny. My grandfather in india had a hearing aid where he could hear people fine, but he couldn't hear phones. (I doubted his honesty of hearing fine, but he could at least understand what I was saying from another room with a north american accent speaking english even though he spoke hindi as a first language). But it never worked over the phone. Bizarre. Shit like that wouldn't ever be tolerated by a north american consumer, or by a north american insurance system (government or private).
It also depends very much on what problem you have. Some of the cheap hearing aids do work fine if you have one type of hearing loss but not another. If you need a bone conduction hearing aid (Baha branded) you're looking at 3grand, if you need a cochlear speech processor you're taking 5k or more. The term 'hearing aid' covers fairly simplistic devices to very sophisticated ones. If you have a rare or complicated problem expect rare, expensive solutions.
Re:Regulated medical device (Score:4, Interesting)
"That's pretty much the only thing you've said that matters. Well that and the fact that most of them are at least partially customized to the patient."
Not as much as you think. They sell previous generation hearing aids as hearing enhancers for hunting. As for the customized stuff, the hearing aid itself just has a an equalizer in it like you'd have for a stereo or software mp3 player and the equalizer is tuned to match your own hearing at various ranges. A hearing test can be administered by software, you could make it a downloadable app with a simple calibration utility. Require it be done with noise canceling headphones and press a button to indicate you can hear the tone or not. When done the software determines the settings for the equalizer and loads them onto the device.
The only downside to not having the medical certification is that the doctor wouldn't sell them, medicaid and insurance wouldn't cover them. But if you could get somebody with deep enough pockets to have the molds and ASICs made for the device and then marketed it cheaply enough for individuals to afford on their own ($50-$100) I'm confident you'd have no trouble recouping the cost and making a hefty profit.
Re:Class 1 Regulated medical device (Score:5, Informative)
Definitely there's more paperwork involved with a Class 1 medical device than say a DVD player, but if both manufacturers follow good management and development practices, it's not really that much more paperwork.
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The tailoring to ear's shape is done in a mass-production style lab where they cast/machine the insert pieces. Just like modern dental labs. All those almost put Ford's early serial production lines to shame :)
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It's amazing how deaf companies are to the idea of lowering price to reach a larger market. Almost every company out there would rather sell less at a higher price.
There are headaches that come along with selling a higher quantity for a lower price. Increased overhead, lower margins, etc.
Re:Because insurance pays for them (Score:5, Informative)
Ok, so if I just pull some random numbers out of my ass... We have 100 people. 50 have insurance and 50 don't. If they sell the hearing aid for $3000, they sell 50 of them. If they sell it for $500 they sell 100. Which makes them more money?
Exactly. In fact, remember those supply-and-demand lines from high-school economics. Basically, your revenue at any given price will be given by finding that price on the demand curve, finding the quantity that it gives you, and you multiply them. The visual way to show this is to make a square with the lower-left corner at (0,0) and the upper-right corner at some point on the demand curve. The area in that square is your revenue. But that is far from your maximum possible revenue. It turns out that, in theory, you could make revenue equal to all of the area under the demand curve. That whole triangle! Usually, that ends up being about 100% increase in revenue.
The way you pull this off is you have to be able to charge $100 from the people who are willing to pay $100 but not $101. And you have to charge $250 from the people who are willing to pay $250 but not $251, etc. In other words, you charge everybody the most that they'll pay. The economics term for this is "price discrimination". Problem is, it's tough to charge different prices from different people. First off, you have the problem of being able to secretly offering different prices to different people. Second, you have the problem of figuring out who's willing to pay more. The internet has made the first problem a non-issue... until people caught Amazon doing it. Remember about 6-7 years ago when someone noticed that, if you went to buy a product on Amazon, and if you were using the same account that you previous used to buy 4 pairs of top-of-the-line Air Jordans, Amazon would quote you a higher price than if your account was used to but Sketchers? Turned out that Amazon was figuring out how "upscale" or how "trailer-park" you tended toward in your purchases, and they could figure out how much more they could squeeze out of you.
An example which is a little closer to the hearing-aid insurance one is that of airline tickets. Ever noticed how it costs so much more to buy a round-trip ticket which does not stay over a weekend? Who would want to not stay over a weekend? Business people. Who's money are they spending? The company's. Are they going to aggressively price-shop or be willing to stay over the weekend for a better price? Nope. So, they can soak the business travelers for more money.
With insurance, it's kinda the same deal. Doctors do have "cash" prices, which they offer to patients who lack insurance, but they can't get too crazy with the price disparity or it'll start looking like insurance fraud.
Re:Because insurance pays for them (Score:5, Informative)
Re:Because insurance pays for them (Score:5, Informative)
Re:Because insurance pays for them -- WRONG! (Score:5, Informative)
MOST insurance policies do NOT cover hearing aides. As a person who's been wearing hearing aides for the last 30+ years, I can guarantee you this. Only if you work for a much larger corporation with a VERY nice benefits package, will you find an insurance policy that will cover your hearing aides - or even a portion of it.
My last pair cost me just shy of $4000. I paid out of pocket since my insurance at the time didn't cover this expense. This is, to date, the second biggest expense I've ever paid, after my car. They were top of the range 11 years ago. I can buy an equivalent model now with the same features from Costco's hearing center now for about $500 each.
Maybe your mum doesn't need the top of the range aides? Try looking for some with fewer features - say only six channels and two or three programs each (one program for normal environment, one for noisy environment, and one for telephone use if she should so desire). You'll save a ton of money.
The other reason why hearing aides are usually so expensive is that not everybody has the same ear shape. All in-the-ear aides are made from a custom mold, which does increase the cost. My dad recently got a behind-the-ear pair that didn't include a custom mold. The tips fit into the canal, similar to a pair of newer earbud headphones. (They still cost him $1200 for the pair though.)
Your mileage may vary. I highly suggest you shop around. Just remember though - you get what you pay for, and always buy the insurance plan on the li'l buggers.
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But the insurance pays up to $800 for a hearing aid. You can't get a digital aid for that little $$$.
I can tell you that the digital hearing aid I have been using for the last twenty years is from ReSound. It is the best I have ever worn, the clarity is excellent and I seldom
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I thought that it was the custom-made nature of hearing aids that made them expensive, but a quick Google shows that a fitted set of earphones cost $200. I figure the fitting process is similar for hearing aids so it can't be the fitting. I guess the problem is that you can get cheap ones for $500 but everyone wants the best of the line models because it's their hearing, not some useless piece of tech that's a luxury.
Re:Because insurance pays for them (Score:4, Insightful)
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.
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What insurance are you talking about? I live in Tennessee, and have top-of-the-line (for us regular folks, anyway) Blue Cross, and having shelled out a used car's worth of money for mine, I can tell you for a fact they aren't covered at all.
Re: (Score:3, Informative)
by i kan reed (749298) Alter Relationship on 2012.06.13 15:23
What competition there is, is in getting doctors to proscribe things, rather than
in getting doctors to proscribe
to proscribe
proscribe
proscribe
*releases a tortured sigh while rubbing his tightly closed eyes*
Re:Because insurance pays for them (Score:5, Insightful)
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.
Re:Because insurance pays for them (Score:5, Insightful)
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.
Re:Because insurance pays for them (Score:5, Interesting)
embrace sells em for $700/ea at the high end. Don't think $2k/ea is reasonable. It's a gigantic crock of BS.
www.embracehearing.com
signed,
hard of hearing anon.
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You, sir/ma'am/other, are my new best friend.
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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.
Maybe you've been out of the job market for a while, but where are these happy employees?
Employers Push Higher Health Insurance Costs Onto Workers [kaiserhealthnews.org]
Employees Get Pinched: Health Insurance Costs More [foxbusiness.com]
Workers paying more for health insurance as costs rise [cleveland.com]
New State-By-State Report: Employer Health Insurance Premiums Increased 50 Percent From 2003 to 2010; Employees' Share of Premiums Increased 63 Percent [commonwealthfund.org]
Employers shift health insurance costs onto workers [epi.org]
Re:Because insurance pays for them (Score:4, Insightful)
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.
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.
Re:Because insurance pays for them (Score:5, Insightful)
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.).
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I always get a laugh when I see people talking about how "business travellers" overpay for executive/first class seats.
We used to fly first class on one of my contracts because last minute tickets (the only way we could book with unpredictable schedules) often found the large number of first/executive class seats selling for up to $100 less than the few remaining coach seats! Who in their right mind would pay more for less?
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Re:Because insurance pays for them (Score:5, Informative)
the main downside to the HSA eligible plans is the high deductibles. There is a requirement that your minimum yearly deductible is $1000 to even qualify for the HSA. And often times it is even higher than that.
Yes they are nice especially when your employer matches your contribution up to $xxx amount. I have had one for 2 years now, and while it does help mainly at the pharmacy it can be burdonsome around the start of the year when that high deductible kicks back in. Unless you managed to get some saved up over the later part of the year.
other issue as to why hearing aids costs so much in the US. Once you add "medical" tag to it here you can instantly increase the price 10x.
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"it can be burdonsome around the start of the year when that high deductible kicks back in. "
Only if you are silly and spend your HSA down every year. I've got $8600 in my HSA right now. that $2000 deductible is nothing. MAybe you need to raise your contribution out of each paycheck and stop buying everything on the HSA card.
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that is sometimes easier said then done when you have kids with expensive conditions that requires costly medication to that is refilled monthly in addition to their medical bills. Not to mention there is a limit to what you can contribute each year (pre-tax anyways). Remember once you tack family on to the plan the deductible sometimes doubles / triples for the whole family. Yes the individual deductible is still the same but you have it for everyone.
Re:Because insurance pays for them (Score:5, Interesting)
If an uninsured dude yet collectible / aka non-judgement proof walks in, they'll probably get the full $350 booked as accounts receivable, then it goes to collections for 25 cents on the dollar for a net income of $87.50 to the Dr which is competitive with the insured pay rate.
Another way to play it is put uninsured dude in accounts receivable as $350, then book a tax deductible $350 loss as a forgiven debt if no collections agency is dumb enough to buy the debt. The real loss is whatever providing the service actually cost, which is probably about half of $95 in your example unless they're operating a charity. So they "really" lost $45 or so of actual medical supplies and labor, not $350. But the $350 loss offsets $350 of income when it comes to tax time so they save perhaps 25% of $350 or whatever that could be as much as $100 tax reduction in exchange for actually losing $50 or so of labor and band aids. The IRS wants their revenue so uninsured dude gets 1099ed as a forgiven debt and gets to pay income tax on the implied income of $350, which for a retail clerk girlfriend with an uninsured broken arm was approximately zero because she made practically no money that year. As I recall it did prevent her from filing the 1040-EZ form and she had to use the 1040 or 1040A something about you can't have 1099 income while filing a EZ form, or at least that was the case in the early 90s. This was some time (decades) ago and the story is related thru a "woman doing taxes" filter so it may or may not be correct. Also her broken arm was an imaginary amount something like $20K not $350. The story originally came from a discussion of "I have to fill out extra paperwork for taxes because of my broken arm before I met you, so I won't get any tax return this year unlike you" type of discussion, leading to the above discoveries.
The above explains why docs and hospitals tend to not really care "if you can pay or not" because either collections or semi-shady tax work lets them get about the same net income even if you never pay them a penny. There will be anecdotal situations where this doesn't work.
I found a good explanation (Score:5, Insightful)
on this silly site [slashdot.org]
Re:I found a good explanation (Score:5, Insightful)
on this silly site [slashdot.org]
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!!!"
Analog is expensive too. (Score:3)
I just got a new Oticon 380p bone conduction hearing end of last year. It was $1,300! Crazy. I assume it is because they are rare since most are digital these days. I refuse to get an implant for digital hearing aids!
I bought the same analog model back in the end of 2004 and it was about $900. Prices keep going up even for old analog ones. :( This specific model has been around since 1994! You can read more about this in details on http://aqfl.net/node/2320 [aqfl.net] ... :(
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Yep. Look up Nager's Syndrome. It's that rare. :(
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The insurance compan
Simple Economics of Scale (Score:5, Informative)
About 2 to 4 of every 1,000 people in the United States are "functionally deaf," though more than half became deaf relatively late in life; fewer than 1 out of every 1,000 people in the United States became deaf before 18 years of age.
However, if people with a severe hearing impairment are included with those who are deaf, then the number is 4 to 10 times higher. That is, anywhere from 9 to 22 out of every 1,000 people have a severe hearing impairment or are deaf. Again, at least half of these people reported their hearing loss after 64 years of age.
Finally, if everyone who has any kind of "trouble" with their hearing is included then anywhere from 37 to 140 out of every 1,000 people in the United States have some kind of hearing loss, with a large share being at least 65 years old.
So even at 140, even ignoring those that cannot be helped by hearing aids and those that cannot afford hearing aids, the truth is that far more than 140 out of 1,000 people buy the products you mentioned. If you move a higher volume, you can price them lower and approach their true cost as your design and overhead costs diminish with numbers. What's more is that "a laptop" will more or less work for me the same as it will work for you. We don't need to mold the laptop to put it in our ears or have it tuned to our needs.
You also seem to overlook two factors: as electronics get smaller they get more expensive. The second part is that as electronics need to power themselves and get smaller they get even more expensive. And on top of that, my cell phone puts out a lot of heat. The kind of heat I would not want in my ear. So you have to consider that the battery must be small and must not dissipate tons of heat and so therefore the electronics must have a very low power draw. There's not much of a conspiracy to find here, it's an unfortunate reality that prevents someone from storming the market with the new better cheaper hearing aid (pending tech advancements).
In my family, we look at chipping in to buy our elders hearing aids for presents, I know the nice ones are crazy expensive.
Re:Simple Economics of Scale (Score:5, Informative)
From Anthony Watts web site supplying some technical info about hearing aids, in his words:
I wear two ITC/CIC hearing aids with DSP processors built in. Let me tell you a little bit about why they are so expensive. The largest supplier of hearing aids in the USA is Starkey in Minneapolis. I’ve been to the factory, and have experienced the process from start to finish courtesy of the president of the company.
1. Because hearing aids, especially BTE (behind the ear) and ITC/CIC (completely in the canal) types use a single cell 1.5 volt battery, which can drop as low as 1.3 volts through its useful operational life, the amplifier circuits must be of extremely low power consumption and low voltage. The only chip material that works well for this is germanium, which has a diode junction forward voltage of ~ 0.3V as opposed to the ubiquitous silicon used in consumer electronics which has an ~ 0.7V forward voltage. While germanium was once very common for transistors and some early integrated circuits, it has fallen out of favor in the microelectronics hearing aid world. There are only a handful of sources and companies now that work with germanium, thus the base price is higher due to this scarcity. You can’t just take an off the shelf silicon chip/transistor and put it in these aids. Each one is custom designed in germanium. [Added: power consumption is a big issue also, aids are expected to last a few days on a single battery, if most of the power is being used to overcome the forward diode voltage, it gets lost as heat instead of being applied to amplification use.]
2. The process of properly fitting a hearing aid is labor intensive. Custom ear molds must be created from latex impressions, and these need to be fitted for comfort. A small variance or burr can mean the difference between a good fitting mold and one that is painful to wear. Additionally, if the mold doesn’t maintain a seal to the inner ear properly the hearing aid will go into oscillatory feedback. Sometimes it takes 2 or 3 attempts to get the fitting right.
3. On the more expensive aids, labor is involved in doing a spectral hearing loss analysis of the user’s hearing problem, so that the aid doesn’t over-amplify in the wrong frequencies. Just throwing in a simple linear amplifier is destructive to the remaining hearing due to the sound pressure levels involved.
4. Construction of aids is done by hand by technicians, especially with the popular ITC (in the canal) aids. At the Starkey company, a technician is assigned to create the aid from the ear mold, fit the chips and microphone/receiver and battery compartment, and connect it all with 32 gauge wire and make sure it all fits in the ear mold. This can be a real challenge, because human ear canals aren’t often straight, but bend and change diameter. Imagine a room with a hundred technicians sitting at microscopes assembling these. Each is a custom job. There’s no mass production possible and thus none of the savings from it.
5. After the aid is created, then there’s the fitting. This process is also hands on. Getting the volume and the audio spectrum match right is a challenge, and audiologists have to have chip programming systems onsite to make such adjustments withing the limits of the aid. Sometimes aids are rejected because the user isn’t comfortable with the fitting, and then the aids go back to the factory for either a new ear mold, new electronics, or both.
6. There’s a lot of loss in the hearing aid business. Patients don’t often adapt well, especially older people. There may be two or three attempts at fitting before a success or rejection. Patients only pay when the fitting is successful. If it is not, the company eats the effort and the cost of labor and materials. Imagine making PC’s by hand, sending them out to users, and then having them come back to have different cases or motherboards or drives fitted two or three times, and software adjusted until the customer is happy with it. Imagine
Re:Simple Economics of Scale (Score:5, Interesting)
2) This is a meaningful cost. A library of semi-custom versions might be a plausible intermediate step. As might laser scanning and 3-D printing.
3) Why can't analysis of the loss can be completely automated? "Press + if this sound is louder than the last one"
4) Flex PCBs (even when each one is fully custom) and 0105 components seem like a plausible solution. Automated assembly has come a long way since the invention of 32 gauge wire. Open your iPhone and count the grains of sand (resistors and capacitors) soldered to the PCB. Sure, they've always done it by hand with microscopes, but while that was a sensible approach 30 years ago, there are better approaches now.
5) This is a meaningful cost, too. But again, there's a lot of "tuning" that could be done by interaction with an automated system.
6) This is a meaningful cost. No obvious way to mitigate it, given the elderly user communicate it.
7) This isn't a cost, it's just a complaint that modern electronics isn't in the picture.
What I hear is "this is the way we've always done it, and we can't imagine a non-evolutionary approach to improvement". Is it really possible that a 3V supply (which would allow use of a $5 2mm^2 32nm-process DSP) would be the kind of disruptive change that would make hearing aids cheap enough for everyone?
Probably not, because the economic argument is unimpeachable: as long as insurance pays for it, and thus eliminates price pressure, there's no motivation to charge much less (10% off for cash, yeah, what a deal). This isn't even value-based pricing (think Mac Pro
Re: (Score:3)
To respond to each and every 'automated system' response: Oh hell no.
For one thing, people are, in general, stupid. For another thing, hearing is a funny thing. Ever have the audiology test where they play high-pitched sounds into your head, and you click the button when you hear them, or think you hear them?
Finally, hearing aids still tend to go to old people. The vast majority of them will not be able to use an automated system.
And the behind the ear models still have custom-fit moulding and what
Simple (Score:3)
cost vs sales curve (Score:3, Insightful)
Oh and the million dollars or more in testing to get FDA approval plays a factor. I have a feeling Microsoft didn't even put a million into testing the Xbox 360 lol.
Re:cost vs sales curve (Score:4, Insightful)
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.
...the world of medical tech... (Score:5, Insightful)
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.
Re: (Score:3)
But is certification really necessary in this case? If a company just made a device to insert in your ear (like an earbud or headset) which amplified sound in a particular way, that wouldn't be much different from a Bluetooth headset or a set of earbuds...I don't see how they could be prohibited from selling them, though perhaps with a different name. Insurance might not pay for them, but if you insurance covers a hering aid then what's the problem?
Re:...the world of medical tech... (Score:5, Insightful)
But is certification really necessary in this case? If a company just made a device to insert in your ear (like an earbud or headset) which amplified sound in a particular way, that wouldn't be much different from a Bluetooth headset or a set of earbuds...I don't see how they could be prohibited from selling them, though perhaps with a different name. Insurance might not pay for them, but if you insurance covers a hering aid then what's the problem?
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.
Re: (Score:3)
People using 5$ headphones are future hearing aid patients.
Re:...the world of medical tech... (Score:4, Informative)
Effective lobbying locks out competition (Score:4, Insightful)
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.
Re:Effective lobbying locks out competition (Score:4, Informative)
Hearing aids are Class 1 Medical devices.... that's the same category as a toothbrush. You don't need to vising a licensed dentist with trade lobbyists to get a toothbrush.
This is why you can buy hearing aids off of TV, the internet, all without a fitting, or a clue what you are getting... Kinda scary because an improper fitting/setting can deafen you.
What I tell people when they ask why they are so expensive - cost in making them. Each hearing aid (in the ear/canal) is custom made by hand, if done wrong, it is re-done at full cost, but the customer doesn't pay for remakes (as stated above). Plus the hearing aid isn't "Make everything louder". It's a very complex device. Think of an expensive home stereo, the type with a bunch of sliders. Now shrink that and put it in your ear. Only have hearing loss in the 1.5 khz range? then that is the only thing boosted... or the sound in that range is shifted up or down. Different environment? have the aid automatically adjust from a noisy lunchroom mode to park mode when you walk outside. Add in directional sound detection so the aid knows the voice in front of you is likely the one you are listening to and not the voice behind you... Add in wireless communication between aids to help find the direction where sound is coming from, plus use media streamers to listen to the TV. Do all of that in something about the size (maybe smaller) than a pen cap.
And no, Health insurance doesn't cover hearing aids (most of the time, maybe there is a few, but that is the exception, not the rule).
Recovery (Score:4, Informative)
Justification (Score:5, Interesting)
Here's an article that attempts to justify the cost:
http://www.aarp.org/health/conditions-treatments/info-05-2011/hearing-aids-cost.html [aarp.org]
Overall cost — $3,600
Costs for the manufacturer:
Materials — $360
Research — $1,080
Other retailer costs:
Rent/overhead — $450
Testing/diagnostic machines — $288
Licenses/insurance — $108
Salaries — $540
Marketing — $270
Continuing education/training — $180
Potential profit for the retailer (pretax) — $324
Approximate product cost for retailer — $1,440
I don't know how accurate it is, but I can believe that the actual parts cost of a hearing aid is around $350.?
Re: (Score:3)
I'll give them parts and manufacturing, but research? Rent? Licenses? Salaries? Etc?
This costs $500 more than an entry-level Mac Pro, which have much the same cost categories, and I'm sure hearing aids sell in much greater numbers for better economies of scale.
The one cost category they obviously missed was "insurance markup" (not to be confused with licenses/insurance).
Re: (Score:3)
I don't know how accurate it is, but I can believe that the actual parts cost of a hearing aid is around $350.?
Pretty high estimate. I've done software defined radio stuff, add a simple microphone and mic preamp and change the software and it would make a killer hearing aid. The point being dedicated SDR hardware has a lovely low noise low intermod input amp, a decent 16 bit A/D, some extremely hefty CPU processing capable of anything a mere hearing aid could possibly require, and a nice low distortion 16 bit D/A and amp. Its hard to find a way to spend more than $50 on materials. Now this might pass thru 5 middlemen, each demanding 50% profit, in which case, sure, the last guy to "pay for hardware" had to cough up $350, because the n-1 middleman made $175 of profit, and the n-2 middleman made $83 of profit, and the n-3 middleman made $42 profit, and the n-4 guy who imported individual components from China made a mere $21 of profit, leaving the foxconn workers $10.50 of revenue. Or something like that.
But does your SDR radio stuff fit in a package the size of your little fingernail and last for days on a battery that weighs less than a gram?
My bluetooth earset / bug / whatever you call it off the shelf at best buy it was $40 in May. Some android software to listen, buffer one second, amplify, echo can, and blast it into my ear SEEMS possible. Its a plantronics M50. My first one was $80 a couple years ago, and replacement purchased about a month ago was $40 before sales tax. In some ways its not terribly durable, but at $40 I'm not too worried if it "only" lasts 2 or 3 years of heavy use. On the other hand, a $40 pair of shoes would never survive near daily used for 3 years either.
Does a hearing aid really "buffer one second" while processing sound? It would be annoying if a Bluetooth headset did it, I can't believe a hearing aid could get away with it - how would that work with people that wear a hearing aid in only one ear because their other ear doesn't have hearing loss.
in-ear sound "amplifiers" are cheap! (Score:3)
Try a non-medical hearing device (Score:4, Interesting)
Do a little googling, and you'll find lots of people writing about positive results using Walker Game Ear devices as cheap hearing aid substitutes. They don't have the frequency fine-tuning that medical devices have, but you can give a $200 Game Ear a try, and return it if it doesn't work. Try that with a $3k hearing aid...
http://www.cabelas.com/catalog/browse/hunting-hunting-accessories-hearing-protection-enhancement/walkers-game-ear/_/N-1100132+1000005098/Ne-1000005098?WTz_l=SBC%3BBRprd708259&WTz_st=GuidedNav&WTz_stype=GNU [cabelas.com]
Assembly and customization (Score:5, Interesting)
Others have mentioned the addition cost associated with it being a medical device, which is not insignificant. Lastly, because many hearing aids are paid for by insurance, rather than out-of-pocket, there is less consumer-driven pressure to reduce costs.
Yea, a _bit_ high :) (Score:3)
I went in a year or so ago to have my hearing checked and found out my ranges but in general everything checked out as ok.
The doctor said I would benefit from getting a hearing aid due to the loss of hearing in one part of my range (bit higher than it should be but not deaf). She was going through the brochure and showing me the aid, a nice one about half the size of a bluetooth ear set. Her nurse checked my insurance company and it didn't provide coverage for hearing aids but I was still interested in the information.
As she was going through the pitch, she was saying "49" "95" as in $49.95. I'm thinking that's a pretty decent price and said that's not too bad, I'd like the one with the red shell. She didn't have any in stock having just sold the last one but could order one for me. She'd have to have a non-refundable $50 deposit though.
And I'm ..ooOO( 50 buck deposit on a $49.95 item? That sounds weird )OOoo..
So I asked and she said, "no, $4,995.00. You thought I meant $49.95??"
Ahh, no. Sorry. It's not all that bad, thanks anyway :)
[John]
I'm no expert. (Score:3)
But couldn't we make these more like cell phones? I see a lot
of people walking around with bluetooth headsets. Rather than
making the hearing aide fit in the ear, make it something I can
wear on my belt, or on a lanyard. The problems of size, power
and heat all become easier to solve.
"Medical and Military Make Money" (Score:4, Insightful)
Because they can. (Score:5, Insightful)
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.
Re: (Score:3)
You make a good argument, and I'd believe you... except that an ER visit to the same hospital, which lasted longer (about 6 hours), involved more tests and machines that go "ping", and more interaction with doctors, nurses, etc, cost 800.00. Hardly cheap, of course, and this was when I *didn't* have insurance and I ended up paying it off over the course of a year -- but it's really hard for me to fathom that 15 minutes of lying still while someone rubbed jelly on my chest (at least she was cute...) costs 20
Re: (Score:3)
Re:Because it's a medical device. (Score:4, Informative)
"my hearing aid made my pacemaker crash" would be pretty shitty.
So would "my hearing aid shorted out and burned the inside of my ear". Or "everyone runs away when I approach because they are tired of the constant feedback my poorly fitted heading aid emits.". So would "I paid extra for a phone that was hearing aid compatible and this hearing aid doesn't work with it."
Re: (Score:3)
So would "my hearing aid shorted out and burned the inside of my ear". Or "everyone runs away when I approach because they are tired of the constant feedback my poorly fitted heading aid emits.". So would "I paid extra for a phone that was hearing aid compatible and this hearing aid doesn't work with it."
But shittiest of all is "You'll have to shout, I can't afford a hearing aid"
There are cheaper hearing aid providers (Score:5, Informative)
also http://www.americahears.com (Score:3, Informative)
I'm a very satisfied customer.
Re: (Score:3, Insightful)
Re:WHAT? (Score:5, Insightful)
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.
Re:WHAT? (Score:4, Informative)
Re:WHAT? (Score:5, Interesting)
Just like college tuition. The easier it is to fund an education the more expensive it gets.
I was going to go there, but the last time I did on Slashdot I was immediately pounced on and pummeled by people who work for universities and colleges. Apparently I had gored some sacred ox.
Finding any historical cost per credit hour data was fairly hard, schools don't really want you to see this.
I finally found some [unk.edu] for the University of Nebraska, Kearney, a state funded school, where a 2011-12 credit hour costs $168. Back in 1964-5 this cost was 9 bucks per credit hour.
Using the Dollar Times [dollartimes.com] calculator $9.00 in 1964 had the same buying power as $65.73 in 2012. So, instead of charging $65.73/ch, UNK is now charging$168, or 2.5 time the inflation equivalent per credit hour.
Kearney isn't alone in this, Central Michigan [cmich.edu] is actually worse.
They charged $85.50/ch in 1993, which had the same buying power as $135.98 in 2012, but they are charging $358/ch or 2.6 times inflation.
Admittedly, state funding levels may have changed, and more money may now be raised by tuition and fees with less tax dollar input.
Its hard to know, without digging thru the University budgets over the years.
But in any event, I suspect that you are correct, that the cost of college expands to absorb the available funds.
Re: (Score:3)
While your analysis is interesting, just measuring the tuition cost increase compared to inflation is insufficient, because as you point out, state funding has probably decreased. The real analysis needs to look at the cost the university spends educating per credit hour and seeing how that has grown compared to inflation.
Put differently, if in 1993 at Central Michigan, it cost $300 per credit hour and the student paid $135.98 and the state paid the balance and today it costs $480 per credit hour, but the
Re:WHAT? (Score:5, Insightful)
Now, I doubt that the problem with affordable education is simply a shifting of funding from the state to the individual
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.
Re:WHAT? (Score:5, Insightful)
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.
Re:WHAT? (Score:5, Insightful)
> 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.
Re:WHAT? (Score:5, Insightful)
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.
Re: (Score:3, Interesting)
Re:WHAT? (Score:5, Insightful)
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.
Re:WHAT? (Score:5, Insightful)
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...
Re:WHAT? (Score:5, Informative)
Even more "Bogus" in that you can get the SAME Siemens #2000.00 hearing aid (US) in Singapore for $180.00 (US).
Re: (Score:3)
plus a couple of weeks of software engineering to tune them to the INDIVIDUAL User.
False. Walk into an audiologist, get plugged into a simple machine to run your audiogram, hook your aides to the computer, push a button and you're done.
The number of completely false claims about the supposed complexity of the hearing aide customization process in this thread is astonishing.
Re: (Score:3)
...and buy a pair of "Hunter's ears". If her loss is broadband, and doesn't require special tuning, the bog standard hunter's hearing assistance device will do what she needs for less than $200 an ear. Mead Killion, the audiologist who started Etymotic Research has written about this problem and has compared off-the-shelf "hunter's ears" with leading hearing aids and, in some circumstances, the hunter's ear was better. As well as a tenth the price. Here's an article from the Wall Street Journal about it. [rasmusen.org]
Forgot to log in before I posted this. May as well use my karma for something.
Re:Maybe because... (Score:4, Informative)
They are in fact mass produced, only the earpiece is custom moulded and that is done by the doctor.
A friend had to get a pair after his hearing was damaged in Afghanistan, a pair of automatic rifles going off next to your head to kill the scumbag running at you with a RPG.
His hearing aids are identical to the ones you can buy for hunting. Except his has a custom software EQ curve installed for his specific hearing loss.
Poverty is a lot more rare than the stats imply (Score:3)
Nope. Not even close. Go look up the numbers and you will see that going back to 1965 the rate only touches 15% from time to time. In fact it would be more accurate to state it as the government redefines the 'poverty line' as needed to ensure that 10-15% of the population will always be in 'poverty' and thus in need of handouts from Democrats.
Sorry, I'm about to be assaulted as a horrible mean person for saying these things. But screw it. As a general rule we don't even know what 'poor' is.
If you live
Re:So what you're saying is... (Score:4, Insightful)
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.