This week we all were treated to the sordid details about who rakes in the big bucks from Medicare. Most interesting to me was the list of specialities in the medical profession that pull in the lion's share of reimbursements.

Opthalmologists, at $3.3 million, had the others beat by a long shot. The second highest revenues were in the fields of hematology and oncology, at just over $2 million.

The number one recipient was Dr. Salomon E. Melgen from North Palm Beach Florida, who received $21 million from Medicare in 2012 alone. He comes with a lot of political baggage and investigations of wrongdoing. The first question that occurred to me was, Opthalmology? The ophthalmologists have a many explanations, including the very expensive drug used for macular degeneration.

But right after that I thought, Where are the ear doctors on this list? Nowhere among the 30 top biggest specialities, the top 2 percent, was any specialty having to do with hearing. No otolaryngologists, no ENT's, no otologists, no speech language pathologists.

Hearing loss is more common in the elderly than vision loss. Just as macular degeneration can lead to blindness, hearing loss can lead to deafness. How could these hearing related specialities not make the top 30, even in the aggregate?

I think there are several answers.

1. Because too many of us assume that hearing loss is a natural part of aging and there's no point in doing anything about it.

2. Because too many of us are embarrassed to admit we have hearing loss, because we don't want to look old.

3. Because too many of us figure that even if we went to an ENT and had our hearing loss diagnosed, we couldn't afford hearing aids anyway.

4. Because there aren't any drugs for hearing loss, at least not any that an otolaryngologist would dispense. One of the more expensive procedures is cochlear implant surgery. But that remains a rarity, especially among the Medicare-eligible demographic.

I looked up my own otolaryngologist. His medicare reimbursements were around $47,000. He's got a long way to go to match Dr. Melgen.

About the Author

Katherine Bouton

Katherine Bouton, a former editor at The New York Times, is the author of Shouting Won't Help: Why I—and 50 Million Other Americans—Can't Hear You.

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