I live in Innsbruck, Austria, where MED-EL is headquartered. Like most people I know, I too have briefly worked there in 2008. I currently live 5 minutes on foot from where the entrance used to be back then, before it was walled off, they massively expanded the building and added another building behind it, where in 2008 a bunch of office containers with clean rooms used to be. There is now a raised walk way to the other side where they used to rent just a few units back then and now co-opted the building, plus a patch work of smaller rental spaces all around.
The implants themselves are not cheap and (at least at the time?) eventually needed to replaced. From what I recall, some of the technology involved was also licensed out or sold for other applications. Ultimately, I would also guess that all the licensing, approval and red-tape involved in actually making implants for humans also kind of limits competition quite a bit.
I think currently it is viable because MED-EL is not a publicly traded company or in the hands of some private equity or some MBA. I know that there are serious concerns how MED-EL will develop when the Hochmaiers are not in charge anymore.
All cochlear implants from any of the cochlear implant companies have a % chance of needing to be replaced. Failure rate is something like 4% in the first 10 years, and 10% in the first 20 years.
Any sane government
And yes, we currently have quite a few sane ones, especially in the EU. None of them is perfect, but it's definitely the most humane it has ever been by a long shot.