Imagine if each state suddenly had laws restricting the sale of mousetraps to licensed “rodent extermination professionals.” Now add a mandate requiring license holders to undergo regular continuing education to ensure that they’re up-to-date with all the latest in spring-loading technology. Why? For safety, of course. Without their expert assistance consumers could hurt their fingers.
Yet laws like this come at cost. The quantity of mousetraps sold would go down, and the cost up, as licensed rodent killers take advantage of their newfound monopoly power. Less obviously, innovation in mousetraps would suffer, as anyone who invents a better mousetrap would have to contend with fifty different state laws and many more licensed gatekeepers just to enter the market.
As absurd as this scenario sounds, it’s the status quo when it comes to hearing aids. Across the country, state-level licensing boards restrict the right to sell hearing aids to audiologists and other “hearing healthcare professionals.” Providers then contract with one or two of the handful of hearing aid manufacturer. This has raised the cost of hearing aids — which are typically not covered by private insurance or Medicare — into the thousands of dollars, and stymied innovative new hearing devices from entering the national market.
The Over-the-Counter Hearing Aid Act, now a provision of the Food and Drug Administration Reauthorization (FDA) Act of 2017, seeks to change this situation. The provision would establish a new over-the-counter (OTC) category of hearing aids meant for mild to moderate hearing loss, supplanting the panoply of state-level dispensing privileges and eliminating the need for consumers to obtain a medical evaluation.
The provision has the support of the AARP, technology focused free-market groups, the Hearing Loss Association of America, and the National Academies of Science, which recommended the creation of an OTC hearing aid category in a report from last year. The bill also has bipartisan support, including Senators Elizabeth Warren and Chuck Grassley and Republican Congresswoman Marsha Blackburn.
You would think a bipartisan effort to improve access to hearing aid technology for the 48 million Americans who suffer from hearing loss would be a no brainer. And yet in the last few weeks, as the bill approaches the finish line, nearly a dozen opinion pieces have popped up opposing the bill from a motley crew of supposedly free-market think tank writers. What the hell is going on?
In some cases, the motivation appears to be a knee jerk suspicion of anything having to do with Elizabeth Warren. For example, George Landrith, whose organization Frontiers of Freedom leads the conservative coalition opposing the bill, recently wrote that he “knew something disingenuous was afoot” before he even read the bill, just because it had Warren’s name on it.
I’m sorry to break it to Landrith, but he and the more than 20 conservative groups who signed his opposition letter have been tricked by fake news. The Hearing Industries Association and the country’s largest hearing aid manufacturer, Starkey Hearing Technologies, oppose the provision because it would increase their competition. Of course, they would never put it in those terms. Instead, people like Landrith, whether he realizes it or not, are doing the dirty work for them by couching cronyism in the rhetoric of free markets.
Landrith even parrots the industry’s talking points, claiming that the provision would lead to “poorer healthcare by eliminating the doctor-patient relationship in finding the right hearing aid and tailoring it to the patient’s needs.” Of course, the only “doctor-patient relationship” that would be severed is a government mandated one. Under the provision, consumers could still consult with their doctor. But they could also choose to order hearing aids directly, and self-evaluate the severity of their hearing loss using online tools, like has happened with direct-to-consumer eyeglasses.
The other misleading claim made by Landrith and company is that the OTC category threatens to regulate “personal sound amplification products” (PSAPs)—the cheaper, unregulated alternative to hearing aids. In fact, there is nothing in the bill that touches PSAPs, except a generic demand for the FDA to update its non-binding guidance on the subject.
The letter was enough to persuade at least one gun rights group to believe their hunting sound amplifiers were about to become regulated like hearing aids. But they have nothing to worry about: The FDA does not have the authority to regulate sound amplifiers and nothing about this bill changes that.
Conservatives believe in the power of competition and deregulation to drive down health care costs. But as the saga of the hearing aid deregulation has shown, industry is happy to fight back by dressing cronyism up in free-market clothing. That’s worse than fake news. It’s fake news that threatens to make anyone with hearing loss thousands of dollars poorer.
Samuel Hammond is a welfare and poverty analyst at the Niskanen Center.