Here’s a story about government doing the right thing that probably won’t get much attention. But the real story is how difficult it was, and how long it took, to fix a problem that affects millions of Americans and has an easy solution. It’s a window into how pathological so much of the U.S. health care system is.

The subject is hearing aids, and if you’re a senior citizen, or know one — your parents, your grandparents — at some point you’ve probably had a conversation about the bizarrely, astoundingly, insanely high price of what are, technologically speaking, fairly simple devices.

On Tuesday, the Food and Drug Administration finally — four years after it was ordered to do so by Congress — released a rule allowing hearing aids to be sold over the counter. If the market works as it’s supposed to, the price of hearing aids should come down dramatically.

That truly bipartisan piece of legislation was signed by President Trump in 2017, but it sat in limbo at the FDA for four years. Back in July, President Biden signed an executive order essentially telling the agency to get off its duff and move this rule through the process. Here’s the White House’s summary of the problem:

Hearing aids are so expensive that only 14% of the approximately 48 million Americans with hearing loss use them. On average, they cost more than $5,000 per pair, and those costs are often not covered by health insurance. A major driver of the expense is that consumers must get them from a doctor or a specialist, even though experts agree that medical evaluation is not necessary. Rather, this requirement serves only as red tape and a barrier to more companies selling hearing aids. The four largest hearing aid manufacturers now control 84% of the market.

The idea that a pair of hearing aids should cost five times as much as the fanciest new smartphone you can buy is completely bonkers. In fact, there’s a market of “personal sound amplification devices” — they can’t be called “hearing aids” since they don’t undergo FDA review — that you can buy for just a few dollars.

But Medicare doesn’t cover FDA-regulated hearing aids, nor does most insurance. It’s an example of how the system has drawn all kinds of arbitrary lines between what is classified as real medical care and what isn’t.

That question is at issue in the debate over the Build Back Better social infrastructure bill: Many in the Democratic Party, led by Sen. Bernie Sanders (I-Vt.), want Medicare to cover dental, vision, and hearing care, on the theory that teeth, eyes, and ears are in fact part of the human body for which people sometimes require medical care.

That provision is supported by President Biden, but Sen. Joe Manchin III (D-W.Va.) seems opposed to expanding the program’s benefits. A proposal to lower the Medicare eligibility age from 65 to 60 has already been jettisoned from the bill; dental, hearing, and vision coverage could be next to go to placate Manchin and Sen. Kyrsten Sinema (D-Ariz.).

But here’s the broader context. The reason we have the most expensive health care system in the world despite leaving tens of millions of people without coverage isn’t that American health care is so spectacular. Our outcomes are on par with, and in some cases worse than, our peer countries that insure everyone for much less cost.

We pay more for everything in health care, from a doctor’s visit to an MRI to the tiniest item on your hospital bill. I once received an encyclopedic bill from a surgery that charged me $5.50 each for some steri-strips, tiny pieces of tape you can buy in a drugstore for a few cents each.

The reason it’s possible is that our system both makes prices opaque and shunts costs from one place to another, all without the government oversight that allows other countries to keep spending in check. If you have good insurance, it might not seem to matter that your MRI cost $1,500, when if you lived in Holland it would have been $190. You didn’t pay it, your insurance did, so who cares? But of course, you did pay it — in higher premiums.

Hearing aids are different: Because the cost is borne directly by individuals, they can see exactly how much they’re getting shafted. Which would seem to make over the counter hearing aid sales a political no-brainer. Yet it still took years for politicians to muster up the will to solve the problem.

And now, finally, the market will have a chance to work the way it’s supposed to: Manufacturers will presumably move in to provide FDA-approved hearing aids at prices that are something like what they should be, and eventually people will be able to get the devices without getting gouged.

Now if we can just do something about the Texas Instruments school calculator monopoly, we’ll really be getting somewhere.