Inusuit, since she's your sister-in-law, please ask her what sort of profit margins are in the business and let us know.
My guess is that it is like most healthcare in the US, and that the primary purpose of audiology in the US is to make money. I am convinced dentistry and optometry are the same. Despite medical doctors being very well paid — the average is $350K per year — they only consume 8.6% of medical spending:
https://wapo.st/3YRWdI5 (So here's to hoping your sister makes a good income!) For the system as a whole — manufacturers, corporate healthcare facility owners, insurers, etc. — the well being of the patient is secondary to making a healthy profit.
I was recently told I have a couple of cavities under two fillings, and that I need these teeth capped. The estimate is well over $3,000. My current Medicare Advantage plan only carries $1000 in annual dental coverage. I have consumed this (and then some) for a deep cleaning of my teeth, something I did annually in Japan for $100 or maybe less. The caps, in Japan, would maybe cost a couple of hundred. Japan has national health insurance, which covers dental as well, and which works very well for medical care in my extensive experience.
(By the way, my Medicare insurance broker tells me that in 2023 at least one Medicare Advantage plan offered $3,500 in dental care, so she thinks in 2024 other plans will try to catch up. I am hoping to put off the $3,000+ in needed dental work until next year if she can find such a plan this fall that covers my my current medical providers.)
While optometry is not covered by national health insurance in Japan, glasses are considerably cheaper. Interestingly, audiology/hearing aids seem to be a similar rip off: I had one buddy, now deceased, who paid about $3,000 for one hearing aid in one ear.
So I am not begrudging your sister-in-law her income, Inusuit, but am curious if she would confirm our consumer beliefs about the profit margin in hearing aids.
The other thought I had re OTC aids is that if you can try them and return them if they don't work well for ya, why not give 'em a shot? My audiologist also told me that they only amplify so are not suited for those with hearing loss in specific frequencies, like most of us with more than very slight hearing loss. But I bet some of the newer ones allow for frequency tuning with a smart phone.