Politically, the red tape set by strict FDA guidelines. That is what prevents some from skipping over HA's and going right for the CI. As a part of the evaluation, they need to conduct speech discrimination test in the best aided conditions of both ears, not just one. If you are over the percentage that FDA requires, then clearly HA's are giving you benefit. CI surgery comes with risks and some of them are not so nice and some of them are corrected with a simple vaccine. For some the risks of the surgery do not outweigh the benefit.
I am thankful that it is difficult to get a CI because since we live in a capitalist country, the surgeon, hospital or audiologist cannot turn it into a get rich quick scheme because of the guidelines. There are audiologist out there that push hearing aids on a patient even if they know there will be no beneft. It is all money in their pocket.
