We’ve been reading in Pat Thane’s book, A History of Old Age, that as hospitals developed in the nineteenth century, the ailing old often found themselves kept out. Doctors and hospitals wanted to cure their patients, and the old were regarded as having an incurable disease — old age — with a known pathology of slow but steady decay. The general view was that the old are inevitably going to loose their teeth, their eyesight, and their hearing, just as they are going to suffer impairments of the mind, digestion, and the heart; and nothing was to be done about it. There was no sense in trying to treat the problems of the old.
Such a primitive view, the reader thinks. Thank heaven we live in a time when so many of the infirmities of old age can be cured or treated and held at bay. We have our medications for gout, glaucoma, indigestion, and high blood pressure. We have our cataract surgeries and our knee and hip replacements. And we’re thankful for it.
But the attitude that the old must endure their suffering prevails in the exclusion of hearing aids, eyeglasses, and dental care under Medicare. Back in the 1960s, when the Medicare law was drafted, hearing loss, declining eyesight, and loss of teeth were regarded as routine accompaniments to aging, not conditions that should be corrected.
Let’s just take the problem of hearing loss. According to a recent New York Times article,
“Congress banned Medicare coverage of hearing aids 50 years ago because ‘people thought hearing loss was just a normal part of aging,’ said Dr. (Christine) Cassel, one of the authors of a recent JAMA editorial on hearing health policies. ‘They didn’t see it as a disability or a medical problem.’”
The hearing aid exclusion is a big problem for America’s seniors. AARP notes that 9 million people over 65 are afflicted by hearing loss, yet according to another source only 30 percent are actually using hearing aids. Cost is a major factor. Estimates of the average cost of a hearing aid range from $1,300 to $3,000, and most people need two of them.
Uncorrected hearing loss is more than annoying to the victim and those close to the victim — it’s dangerous. Drivers and walkers need good hearing in order to avoid accidents. Studies show that those with hearing loss have more falls, more hospitalizations, and more physical and mental problems overall.
Worst of all, hearing loss is associated with dementia and abnormal brain shrinkage. Dr. Frank Lin of Johns Hopkins has found that the brain’s “temporal gyri,” involved in hearing, are particularly affected by shrinkage among the hearing impaired; but these structures also “play roles in memory and sensory integration and have been shown to be involved in the early stages of mild cognitive impairment and Alzheimer’s disease.”
Hearing loss is anything but a routine aspect of aging that can be safely ignored. Representative Debbie Dingell of Michigan recognizes this and has introduced H.R. 1653, the Medicare Hearing Aid Coverage Act, to end the Medicare hearing aid exclusion. Florida Democrat Alan Grayson has gone her two better with H.R. 3308, the Seniors Have Eyes, Ears, and Teeth Act, requiring coverage of eyeglasses and dental care as well.
Meanwhile, the President’s Council of Advisors on Science and Technology is recommending federal actions to decrease the cost of hearing aids and to make a basic model available over the counter.
Congress fell victim to a primitive view of old age in 1965, when it excluded hearing aids from coverage under Medicare. The time for action to correct this mistake is long past.