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Comment by lvspiff | Hacker News Reader

As a spouse of someone with a cochlear implant I've asked this question repeatedly. The cost of everything around that hearing device is insane - want a cord so you can listen to audio? That's $500. Want a device to make it easier to hear TV? That's another $750. Operate over bluetooth? Nope we can't do that. Need a new battery? That's a grand. Its insane what they get away with

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Don't forget that cochlear implants are basically a locked-in monopoly. If you've got an implant from company A, then you're stuck with company A's processors and accessories unless you plan on having another surgery to take out the implant and put in a different one -- which most surgeons would not recommend for any reason short of actual damage.

I picked Advanced Bionics and regularly pay around $2000 a year in batteries, parts (cables, various pieces) etc. alone -- none of which is covered by my insurance here in Japan. Currently I'm waiting on a replacement processor (which is two or three generations old) that I'll pay around $600 out of pocket for. It doesn't seem like much, but due to rain and humidity I end up opening it myself and cleaning it several times a year because I can't afford to get it repaired/replaced.

If I want to upgrade to the newest processor, which is lighter, has better audio quality, and is MUCH more water resistant (a major problem with my current model), it will cost me around $7000 -- and that's a DEAL because the processor JUST got approved in Japan.

After March 2018, the price will go up to $14,000 for a processor. Of course, it's not covered by insurance, so I have to pay for it all out of pocket.

I asked the doctor I was seeing what Japanese cochlear implantees do; I've seen so few successful/independent ones and couldn't imagine any of them paying for any of this. He said they usually hobble along with replacement parts/charity and never upgrade the processor because they can't afford it. He also mentioned that many of them have such a low level of recovered hearing and speech that newer processors, frankly, would not give a measurable QOL benefit, which is another rant entirely...

I'm glad I'm not bilaterally implanted -- there's no way I could afford TWICE the costs.

That's the great thing about being in New Zealand, I get upgraded for free every 7 years. A pack of 50 batteries will cost me $30. But mine has rechargeable batteries too if I need.

Surprised Japan doesn't do the same. However, maybe it's an Advanced Bionics thing - we can't get them on the public system here. I chose Med-el (the other option is Cochlear).

I'm on AB and my friend is on Cochlear; he's always amazed at the terrible service I get and the prices I pay.

> I get upgraded for free every 7 years.

I trade mine in for replacement (on my dime) because it's completely broken every 4-5 years.

> A pack of 50 batteries will cost me $30

A single battery runs me around $200-300. My charger breaks all the time too, so that's another $100-200 depending on what's broken... how are you getting a pack of 50 for $30? What do you even do with 50 batteries?

I have four that I cycle through (the big powercels) but that's because I apparently have thick skin/a thick skull and I only get 10 hours of use out of a battery rated for 20+.

Edit: Oh -- misread! I thought you said you were on AB, but you've got a MedEl. I don't think I've ever actually seen those... they weren't even an option at Hopkins when I was going through the pre-screening. The two options I got were AB and Cochlear.

That's odd, if it's completely broken before 7 years, then it's replaced under warranty for me. Still free.

By batteries, I'm talking disposable batteries, not the rechargeable ones. So 50 will last me a while. I like the disposables best.

This is mine: http://www.medel.com/int/sonnet

That sounds like exactly the kind of thing that government should regulate with extreme prejudice. Really, anything that gets implanted into one's body, and is not easily swappable, should be.

I'm doing a little better with a Cochlear Freedom. Granted the processor costs $15,000 out of pocket, but my last one lasted 7 years without problems, and my replacement cost was reduced to about $700 through a government program. Said government program is not reliable - I have to jump on it when the money is available, god help me if my CI fails when the money isn't there.

Batteries are about $500 each and they last at least a year before they start to degrade. Accessories are not only absurdly expensive, but also basically useless, so I don't waste money on them. It could be a lot worse. It could also be a hell of a lot better. I'd like to be able to hear on my left side too, almost badly enough to pay the $50,000 or so out of pocket that it will cost to get the second implant. My main problem is figuring out who to give the money too. Privately-paid health care is more difficult to get than I imagined.

> Batteries are about $500 each and they last at least a year before they start to degrade.

Wow, that sounds killer for me. My batteries are about half that and last the same amount of time; I buy four or five a year since I cycle through them due to my thick skin/skull that causes me to get half the expected life out of them every day...

What about cables/headpieces/earpieces for that?

Is your government program the Office of Vocational Rehabilitation, by any chance? I went through them in PA and they were spectacularly flaky... and it wasn't helpful that my liaison was someone I'd known for a while since I was friends with her son and she kept pushing me to "give back" in return for receiving benefits.

No, Canadian here, which explains most of the price difference as well. CAD is weak at the moment. There's a waterproof sleeve thing that you can use for swimming - I believe that was $700. There's a bluetooth dongle that works with my iphone, but it's incredibly frustrating to use, so I mostly don't. That was $350 if I recall. All these things are tax write-offs for me, which is helpful, but I still have to pay out of pocket. It doesn't help much in low-income years, either.

BC Medical tends to get a pile of funding every couple years for CI patients, like 10 million or whatever, and out of that pile they prioritize younger adults who need at least one CI to be able to hold down a job, people whose equipment is starting to fail, etc. If there's any left after everyone who needs one CI or replacement equipment has got what they need, they can offer second implants. They've never gotten that far down the list though.

> BC Medical tends to get a pile of funding every couple years for CI patients, like 10 million or whatever, and out of that pile they prioritize younger adults who need at least one CI to be able to hold down a job, people whose equipment is starting to fail, etc. If there's any left after everyone who needs one CI or replacement equipment has got what they need, they can offer second implants. They've never gotten that far down the list though.

That sounds like a relatively reasonable methodology... I would really like to see the balance sheets of these companies to see how much they're gouging us -- I refuse to believe that what's essentially a condom and plastic tweezers really costs $700.

>I would really like to see the balance sheets of these companies to see how much they're gouging us

Not broken down to each accessory or anything, but you can see overall profit margins and such.

https://www.sonova.com/en/first-half-results-201617-sonova-s...

http://www.cochlear.com/wps/wcm/connect/b0dffcb0-9826-4c99-9...

Likewise, my best mate has had hearing aids since ever, and now a cochlear implant. According to him, the official line is that prices are high because volumes are low and medical devices are expensive to design. The unofficial line is that they're price gouging because they have a captive market and no real competition.

If I needed hearing aids, I'd pay anything for them.

Presuming you have access to the money and/or some expensive insurance to cover them. Don't forget about 99%.

And that's the reason why anything and everything medical costs as much as can be gotten away with.

You've just described the intersection of capitalism and human survival instinct in a nutshell.

Yep, and the reason why governments are useful in the first place. To protect us against capitalism failures.

You need water to live and would pay anything for it, but this is not sufficient to explain a market failure.

I was under the impression that modern water markets were all either massively regulated in response to historical market failures (public utilities in developed nations) or currently undergoing market failure (developing nations, c.f. Nestle's shit in Africa).

As far as I know, there's no real water market anywhere, it's all granted by governments. Unsurprisingly, some governments are better than others at managing such resources, and large companies take advantage of that.

My point is not that markets in water and hearing aids can't fail, it's that "the demand curve is almost completely inelastic" isn't an explanation. Water and sewage are generally provided by public utilities (in non-rural areas, at least), but the conventional justifications involve the "natural monopoly" of the associated infrastructure, not the shape of the demand curve. People in developed countries would pay almost anything to have flushing toilets, but septic systems (to which infrastructure arguments don't apply) are usually provided by private companies.

My daughter played with another child with cochlear implants the other day and as far as I could tell her hearing was perfect.

My mother, who was deaf and wore hearing aids, died in 1989. I always wonder what difference they could have made to her.

That presupposes you'd have the money for them. I'm fortunate to be able to either have had insurance coverage or pay $5-6000 out of pocket every 3-5 years for new hearing aids, but there are many many people who can't afford that.

This is the reality. Prices are set based on what the market will bear, which is determined primarily by what health insurance will pay for. The same HA or CI costs different amounts depending on whether you're buying it in the USA, Europe or Australia.

If you're paying out of pocket, I strongly recommend that you check out eBay. Second-hand gear is quite cheap.

Building medical devices is extremely difficult due to regulation. I don't know if they are price gouging or not, but it is expensive to do.

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