Crosspost from my blog.

Context

Inequality is a common and legitimate worry that people have about reprogenetic technology. Will rich people have super healthy smart kids, and leave everyone else behind over time?

Intuitively, this will not happen. Reprogenetics will likely be similar to most other technologies: At first it will be very expensive (and less effective); then, after an initial period of perhaps a decade or two, it will become much less expensive. While rich people will have earlier access, in the longer run the benefit to the non-rich in aggregate will be far greater than the benefit to the rich in aggregate, as has been the case with plumbing, electricity, cars, computers, phones, and so on.

But, is that right? Will reprogenetics stay very expensive, and therefore only be accessible to the very wealthy? Or, under what circumstances will reprogenetics be inaccessible, and how can it be made accessible?

The question

To help think about this question, I'd like to know examples of past technologies that stayed inaccessible, even though people would have wanted to buy them.

Can you think of examples of technologies that have strongly disproportionately benefited very rich people for several decades?

Let's be more precise, in order to get at the interesting examples. We're trying to falsify some hypothesis-blob along the lines of:

Reprogenetics can technically be made accessible, and there will be opportunity to do so, and there will be strong incentive to do so. No interesting (powerful, genuine, worthwhile, compounding) technologies that meet those criteria ever greatly disproportionately benefit rich people for several decades. Therefore reprogenetics will not do that either.

So, to falsify this hypothesis-blob, let's stipulate that we're looking for examples of a technology such that:

• ...it could be made accessible.
  • In other words, there's no clear obstacle to it being accessible to many people inexpensively.
  • For example, we exclude all new products—anything that's only been offered at all for less than, say, 10 years or something. There has to have been sufficient opportunity for people to make it accessible.
  • For example, we exclude space travel. For the time being, it's intrinsically extremely expensive.
  • For example, we exclude gold-flaked ice cream, because gold is just rare.
  • However, enforced / artificial scarcity could be interesting as an edge case (if it's a genuine technology).
• ...people have, prima facie, had plenty of incentive to make it accessible.
  • In other words, there should be a substantial market demand for the technology. Otherwise, it's probably clear enough why it hasn't been made accessible—probably no one tried.
  • (If there's some complicated or unintuitive reason that people don't actually have an incentive to innovate despite unmet demand, we include that; such an example would be revealing about why this situation can occur.)
  • For example, we exclude expensive medical treatments for super-rare diseases.
• ...it is very expensive to access, but rich people can access it.
  • This could be for basically any reason. The product itself might be high-priced, or it might be highly regulated so that you have to fly to some remote regulatory regime to access it.
  • I'm not sure what the bar should be. \$50K definitely qualifies as expensive. \$5K is much more ambiguous, and I'd lean towards no because many people have cars that are more expensive. (They finance their cars, but we could also finance reprogenetics.)
• ...it is actually a genuine technology, rather than being just a really big expenditure.
  • For example, we don't include yachts. We also don't include technologies that are somehow very yacht-specific.
  • We don't include diamond-studded or gold-leafed anything.
• ...it is much more beneficial compared to analogous inexpensive products.
  • E.g. we exclude a \$10 million car that's mainly expensive because of branding, status signaling, etc., and doesn't have much significant technological advantage over a \$100k car.
  • But we do include expensive medical treatments that are much more effective than a slightly effective cheap treatment.
• ...ideally, it gives the user of the technology some additional compounding advantage over non-users.
  • E.g. computers, nutrition, education, training, health, etc. The point is to model the "runaway inequality" aspect.

We can relax one or more of these criteria somewhat and still get interesting answers. E.g. we can relax "could be made accessible" and look into why some given technology cannot be made accessible.

Some examples

• The Bloomberg Terminal. (But this was more like artificial scarcity, IIUC.)
• Fast exchange connections for high-frequency trading. (Not sure if this qualifies.)
• Prophylactic medical testing. E.g. MRI scans (something like a few thousand dollars).
• Supersonic flights?
• IVF (can cost in the ballpark of \$20k for one baby).
• IVIG infusion (biologically scarce?), continuous glucose monitoring, monoclonal antibodies, various cancer treatments.
• Cosmetic medical procedures. (However, actually these tend to be basically accessible, just "kinda expensive".)
  • Plastic surgery.
  • Advanced dental care
    • Invisalign
    • Dental implants
  • Hair implants
  • LASIK
• Home automation systems?

What are some other examples?

Assorted thoughts

In general, necessary medical procedures tend to be largely covered by insurance. But that doesn't mean they aren't prohibitively expensive for non-rich people. Cancer patients especially tend to experience "financial toxicity", i.e. they can't easily afford to get all their treatments so they are stressed out and might not get all their treatments and they die more. There's some mysterious process by which drugs cost more with unclear reasons ^[1] (maybe just, drug companies raise the price when they can get away with it). This would be more of a political / economic issue, not an issue with the underlying technologies.

Some of these medical things, especially IVF, are kinda worrisome in connection with reprogenetics. Reprogenetics would be an elective procedure, like IVF, which requires expert labor and special equipment. It probably wouldn't be covered by insurance, at least for a while—IVF IIUC is a mixed bag, but coverage is increasing. This suggests that there should maybe be a push to include reprogenetics in medical insurance policies.

Of course, there are many technologies where rich people get early access; that's to be expected and isn't that bad. It's especially not that bad in reprogenetics, because any compounding gains would accumulate on the timescale of generations, whereas the technology would advance in years.

1. Lalani, Hussain S., Massimilano Russo, Rishi J. Desai, Aaron S. Kesselheim, and Benjamin N. Rome. “Association between Changes in Prices and Out‐of‐pocket Costs for Brand‐name Clinician‐administered Drugs.” Health Services Research 59, no. 6 (2024): e14279. https://doi.org/10.1111/1475-6773.14279. ↩︎