Medical Transcription? What is happening!

Why are so many transcription company's struggling? Are we stuck in a vice grip? MVTS contracts with some of the BEST medical word specialists in the industry. However, new technology is forcing rates down further and further, which, in turn, forces MT rates down. The company itself has to make some profit to stay viable in the industry. What we find is an unbalanced formula. If 4 + 9 = 11, then we are in decent shape (4 being the profit, 9 being the expense and 11 being the client rate). However, If 4 + 9 = 13 but nobody will give us 13, what does one do? What are your thoughts?