Senator Manchin, others should listen to the compelling arguments for hearing aid coverage in Medicare


An older man who is hard of hearing can become quite anxious when he reads that hearing loss is the biggest treatable risk factor for dementia. The good news is, it’s treatable. The bad news is that most people can’t afford the main treatment, hearing aids.

Peer-reviewed studies have confirmed a link between hearing loss and accelerated cognitive decline. This is a particular problem for the most hearing impaired population, the elderly.

US Senator Joe Manchin, D-West Virginia and other lawmakers should be aware – that millions of older Americans on Medicare suffer from hearing loss (including a significant portion of his State). He should know that people who cannot hear well are more vulnerable to memory loss, awkward pauses, more mental missteps (some potentially dangerous) than those without hearing loss.

In the equally divided US Senate, Manchin’s vote can make or break the platform of President Biden and the Democrats. This is why his preferences for the content and content of legislation carry so much weight.

During the ongoing negotiations on the Democrats’ Social Spending and Climate Change Bill, one of the red lines drawn by Manchin is a proposal to expand Medicare to pay for hearing aids for people elderly. Medicare dental and vision coverage proposals were previously removed from the bill after Manchin’s opposition.

The senator cites concerns about the long-term sustainability of Medicare’s financial base with any costly expansion of the program. Yet Manchin also opposes raising taxes on the very wealthy and businesses to help pay for the variety of social programs in the Build Back Better Bill.

By opposing all possible methods of paying for the expansion of Medicare and other popular benefits in social spending legislation, the West Virginia senator has pushed overboard a founding principle of the political party he belongs – asking the wealthiest citizens and businesses to contribute a fair proportion of their income to help society as a whole. Currently, many of these people pay little or no tax.

However, it is difficult to live up to Manchin’s so-called principled concern about the future of Medicare. This senator refuses to consider reasonable ways to protect that future while paying for an expansion of vital services.

It seems to me – someone at higher risk of dementia due to mild to moderate hearing loss – that this very serious health problem is at least as urgent as most – maybe even most – of the health costs that Medicare and private insurance cover. This is something that a significant percentage of seniors cannot afford to resolve without the help of their insurance and / or Medicare.

AT THE FIRST DIAGNOSIS with hearing loss last spring, i was amazed to learn the links to cognitive decline. As a 66-year-old Ohioan, I assumed that the worst effects of my hearing loss involved having to use closed captions on TV and participating in loud, questioning comedic exchanges with my wife, Morty-style. and Helen, Jerry’s parents on “Seinfeld.”

Assumptions like these have kept hearing aid coverage out of Medicare since its inception: that “losing hearing is a normal part of aging”; that the elderly can remain more or less functional even if they are “a little deaf”.

Two peer-reviewed studies, one published in 2013 and another in 2019, confirmed the links between hearing loss and cognitive impairment. The second study, published in JAMA Otolaryngology – Head and Neck Surgery, found this connection at virtually any level of hearing loss above zero.

An article in the New York Times Magazine in February 2020, titled “Can Hearing Aids Prevent Dementia?” ” summarized these studies.

The 2013 study, “Hearing loss and cognitive decline in the elderly,” according to the article, “found that a subject’s likelihood of developing dementia increased in direct proportion to the severity of their hearing loss at the time. The relationship appears to be “very, very linear,” says study lead author Frank Lin, which means that the greater the hearing loss, the greater the risk of developing the disease.

In 2017, the article added, Lancet, a respected medical journal, appointed a commission review all published research on risk factors for dementia “that could be changed to prevent or delay the onset of symptoms.” Hearing loss won this dubious competition, accounting for 9 percent of dementia diagnoses.

What is less certain, as the NYT Magazine headline suggests, is to what extent (if any) hearing aids and other treatments for hearing loss reduce the risk of dementia in the elderly. (They probably wouldn’t change the risk of Alzheimer’s disease, which results from a brain condition probably unrelated to the hearing loss.)

Yet Lin told NYT Magazine that given the main assumptions about the link between hearing loss and cognitive decline, “there’s every reason to think that if you treat the hearing loss, these interventions could directly alter these pathways ( neural) ”, reducing the link.

To be too simplistic, if being hard of hearing interferes with your thinking ability, wouldn’t repairing hearing stop the damage?

The problem is, “repairing hearing” by the main means available, hearing aids, is prohibitive for most people.

According to the NYT Magazine article, two-thirds of adults aged 70 and over have hearing loss. Yet in the United States, only 14% of hearing-impaired adults actually use hearing aids.

The latter statistic is likely due to a mixture of old assumptions (“hearing loss is a normal and acceptable part of aging”) and the exorbitant cost of a pair of hearing aids. While much cheaper no-frills options are available, the cost can easily exceed $ 6,000 if the price includes expert appraisal and testing, better hearing aids, follow-ups, regular cleaning, and multi-year warranties. .

They don’t last forever, so if you buy a pair of hearing aids at age 65, you may need to buy a couple more before you die. Few retirees can easily produce several thousand dollars for what they are conditioned to consider a discretionary purchase.

It’s no wonder that when faced with this large expense – equal to several months of rent or rent, or groceries for six months – most people simply accept the fact that they can’t hear very well. They go on with their lives, unaware that their hearing loss accelerates cognitive decline which negatively affects quality of life and family relationships on many levels.

Helping these people seems a worthy candidate for federal government help, certainly as worthy as the panoply of health problems eligible for reimbursement from Medicare and / or private insurance.

AFTER READING ON THE LINKS between hearing loss and cognitive decline, I bit the bullet and last week spent some of my retirement savings on hearing aids. It is more than a year too early to qualify for a Medicare extension for hearing aids, which will not take effect until 2023.

With my new hearing aids, so far everything has been fine. Everything looks crisper and sharper when I have them in it, and tinnitus is more like a balmy spring night than a summer full of cicadas. I hope they will help delay mental decline.

Clearly, this plausible remedy for a frightening and debilitating affliction should be available to more people than the relatively few who are willing and able to pay several thousand dollars out of pocket.

So far, Senator Manchin has refused to hear the convincing arguments for extending Medicare to pay for hearing aids. Maybe if enough people are screaming in his ears, he will.



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