One point many are missing here is that hearing aids are only PART of the rehabilitation process.
I don’t sell gadgets, I sell better hearing. That includes my expertise selecting and programming the aids to best fit the patient (just read some of the horror stories on here about incompetent programming if you don’t think that’s a valuable skill), counseling, repairs, cleaning, hand-holding, and whatever else is needed. My patients can make same day appointments Mon-Fri, and I’m available evening and weekends if needed. I’ll make house calls if someone can’t get to me. I can sell hearing aids from any of the major manufacturers (not just whatever the head office tells me we have on contract at the moment) and I can get the latest technology as soon as it’s released (or even earlier with beta releases). Made for iPhone aids, CROS aids, or tinnitus aids, not a problem. I’ve had them since they came out.
Big Box stores like Costco or Walmart can sell their hearing aids for less than me because they have much less overhead for their hearing aid stores. They can make money off toilet paper or whatever, and they also can purchase their aids for MUCH less than I can. They don’t have me though! There will always be people who want to get their healthcare for the least amount possible, and that’s fine for them. I have plenty of patients who are happy with me and my services. I had one patient tell me he’d shopped around, and I wasn’t the cheapest, but he decided to go with me because I was the best.
Come on, do you really think the metal and rubber bands on your child’s braces cost thousands of dollars? Or are you paying for the orthodontist’s expertise? How about your surgeon? Do you ask him/her how much your knee implant costs, and then add $450 on top of that and think that should be “enough profit” for them? Same thing for your mechanic. Doesn’t matter if it only took him 30 seconds to diagnose and fix a problem, it’s something I can’t or don’t want to do so I’m going to pay him gladly. I see value in those services.
BTW, I do agree with Doc Jake (I know Jake, don’t fall off your chair!) with REM not being a panacea. It’s great to tell you where you’re starting at, but if it sounds sucky to the patient you’re still going to adjust things so that’s it’s acceptable to them and they’ll actually wear their aids. Doesn’t do them any good if they hit every target and they hate the sound so they stick them in the drawer. That’s where the experience, programming and counseling skills come into play.