One of the casualties of our day is respect for expertise.
One reason is that so much information is instantly accessible to everyone, but it goes beyond that. Recently PBS ran a remarkably non-partisan piece called “The problem with thinking you know more than the experts.” It suggests the blame runs deeper than our device-centric lives:
The smartphones and tablets that we carry around all day that we think can answer anything are only part of the problem. The American educational system, from grade school to graduate school, encourages students to think of themselves and their views as special.
The left in particular likes accusing Republicans of rejecting their experts on highly politicized issues while blithely rejecting experts they don’t like, like financial experts talking about our long-run entitlement problem.
Right now, Sen. Elizabeth Warren (D-Mass.) is doing just that with hearing aids.
Warren is the Senate sponsor of the Over the Counter Hearing Aid Act of 2017, which would create a new over-the-counter (OTC) category of hearing aid, ostensibly to make it easier for people to access new technology to help them hear. Warren and her allies insist that moving to an OTC model will boost innovation, savings, and patient access.
These are noble goals, but the reality is a bit more complicated.
This legislation is actually a backdoor for imposing new FDA regulations on existing personal sound amplification products (PSAPs), currently defined by the FDA as wearable electronic products intended to augment sounds for people who are not hearing impaired. They are not medical devices that require a prescription from an expert. PSAPs are the audial version of sunglasses, like the Personal Sound Amplifier sold at Walmart, and are already available over the counter without a prescription.
To help Warren’s corporate allies, this bill would impose stricter regulations on these products. She’s working for big corporations, like Massachusetts’ own Bose, to deliver not happiness and joy to all children everywhere, but simply more regulations, less state’s rights, and potentially poorer health outcomes.
In essence, Warren and the corporations pushing this legislation want the FDA to regulate hearing aids and PSAPs the same way, which would give PSAPs more credibility than they deserve and could make acquiring a functional, affordable hearing device more difficult for people.
A hearing aid is a much more complicated device, and getting one requires a licensed audiologist – an expert – to examine, diagnose, and prescribe. Audiologists don’t just customize hearing aids properly, but they also look for more severe medical issues. Without their expertise, other more serious issues might go untreated, such as otosclerosis and more involved ear pathologies.
“I have seen patients come into my clinic with hearing tests provided by ‘big box stores’ who should have been referred for ENT management but were not. … In one case, patient had a tumor on his auditory nerve. Had these patients not come into my clinic for a second opinion, this dangerous management of their care could have escalated into serious health problems.”
Warren is not going to restore hearing to the deaf with the wave of her pen–she’s going to interfere with an already functioning industry and deter some people who need actual medical attention from getting it, while saving no one any money.
And despite the insistence that this will help making hearing care more affordable, many people could actually lose coverage under this. We have seen this with private insurance plans, which have dropped coverage of certain drugs as soon as they become available over the counter. The federal law change would preempt state Medicaid policies and could potentially lead Medicaid to drop audiology and hearing aids from their insurance coverage altogether.
Blue Cross Blue Shield has an entire section of its website dedicated to medications they don’t cover because they’re available OTC, and Medicare Part D usually doesn’t cover OTC drugs. The New York Times reported that “If your insurer covers the bulk of your prescription bill and your copayments are low, you will probably have to pay more money when a medication starts to be sold over the counter.”
It is (yet) another example of the Democrats impinging on the rights of states to self-govern on issues like this. States should certainly have the authority to implement laws like this but have wisely chosen not to. Some politicians in the Maryland State Assembly recently tried to implement something like this, but the proposed legislation didn’t even get out of committee, which is of course good news for people in the Old Line State.
We can trust and hope that Sen. Orrin Hatch, who has always been a stout defender of states rights and sound health care policy, can appreciate the issue at stake. As a senior member of the Health, Labor, Education, and Pensions Committee, which just passed the bill out of committee, as well as chair of the Senate Finance Committee, he will doubtless play a key role in this legislation when the full Senate considers it soon and can be counted on to fix it.
The advocates for changing how we regulate hearing aids have sold it as a path to savings and innovation, but the reality is that it is anything but. It would usurp states’ powers, give even more power to the regulatory state, remove health care experts from clinical decisions, and likely increase out-of-pocket costs for patients who can afford it the least. And it won’t help the people it’s supposed to be helping.