By Futurist Thomas Frey
The Choice That’s Coming for All of Us
Imagine your doctor calls with good news. There’s a new treatment that can edit your genes to eliminate your risk of the heart disease that runs in your family. Or erase the Alzheimer’s gene you inherited from your mother. Or cure the Parkinson’s symptoms you’re already experiencing.
One treatment. Permanent fix. You’ll never develop that disease.
Do you say yes?
Most people would. Of course they would. Who wouldn’t want to eliminate a deadly disease from their body?
But there’s a catch: It costs $200,000. Insurance doesn’t cover it yet. And only certain hospitals can perform it.
Now imagine this treatment has been available for ten years. Some people got it. Many couldn’t afford it. The ones who got it are healthier, live longer, and spend less on medical care. The ones who didn’t are still at risk, still getting sick, still facing the diseases their genes predispose them to.
This isn’t science fiction. Gene editing treatments already exist. The FDA has approved therapies that cure sickle cell anemia and certain genetic blindness conditions. Scientists are developing treatments for Parkinson’s, heart disease, and dozens of other conditions. Some can be administered to adults. Some work best before birth. All of them are expensive.
The question isn’t whether this technology will exist. It already does and it’s expanding rapidly. The question is what happens to society when gene therapy becomes routine for people who can afford it, while everyone else stays sick.
How Gene Therapy Actually Works at Different Ages
Let me explain the basics because this is more flexible than most people realize.
Your body is made of cells. Inside each cell is DNA—the instruction manual for building and running you. Sometimes there are errors in that manual. These errors cause diseases. Some make you develop cancer. Some cause your heart to fail. Some lead to Alzheimer’s.
Scientists can now fix these errors at different life stages:
Before Birth. You can edit genes in an embryo, just a few days after conception. Fix the error before the baby develops, and they never have the disease gene at all. This is what China did in 2018. It’s controversial and illegal in most countries, but technically possible.
In Children and Adults. You can use gene therapy to fix genes in someone who’s already alive. This is what the FDA-approved treatments do now. They deliver corrected genes into your body using modified viruses or other methods. Your cells start using the new, correct instructions.
For Active Diseases. You can even treat people who already have symptoms. There are gene therapies now that slow or reverse Parkinson’s symptoms, cure certain types of blindness, and eliminate sickle cell anemia in adults who’ve had it their whole lives.
The technology exists across all these stages. The question is cost and access.
A gene therapy that cures sickle cell anemia currently costs $2 million per person. A treatment to reduce Alzheimer’s risk might cost $500,000. Editing genes before birth might cost $100,000 per child. These numbers will drop over time, but right now, only wealthy people can afford them.
The Two Tiers of Humanity
Here’s where things get uncomfortable. Let’s think about what society looks like ten years from now when gene therapy is routine for some people but not others.
The Gene-Edited Humans. These are people who’ve received gene therapies throughout their lives. Maybe they got preventive treatments before birth. Maybe they got therapies as adults to eliminate disease risks. Maybe they got treatments that cured diseases they already had. Either way, they don’t face the genetic diseases that natural humans face. They live longer—maybe to 100 or 110 instead of 75 or 80. They have fewer health problems. They spend less on medical care. They miss fewer days of work due to illness.
The Untreated Humans. These are people who can’t afford gene therapy. They get sick like humans always have. They develop cancer, heart disease, Alzheimer’s, Parkinson’s. When gene therapies could cure or prevent these diseases, they die from them instead. They live shorter lives. They spend more money on managing chronic conditions. They miss more work. They face genetic risks that edited humans have eliminated.
Now imagine these two groups trying to compete in the same society.
Who do employers prefer to hire? The person who’s been genetically optimized and rarely gets sick, or the person who might develop a chronic condition? Who do insurance companies charge less? Who can afford to take bigger career risks because they’re not worried about healthcare costs?
The edited humans have an advantage in almost everything. Not because they’re smarter or work harder, but because they could afford to fix their genes and others couldn’t.
The Rich Get Healthier, The Poor Stay Sick
The really disturbing part is how this amplifies existing inequality.
Gene therapy is expensive. A treatment for sickle cell anemia costs $2 million. A therapy to prevent Alzheimer’s might cost $500,000. A preventive treatment before birth might cost $100,000. Even as prices drop, these will remain expensive for years.
Rich people will get these treatments. They’ll eliminate their disease risks, cure their conditions, and live longer, healthier lives. Poor people won’t have access. They’ll get sick, struggle with chronic conditions, and die from diseases that could have been prevented or cured.
Twenty years later, the rich people are still healthy and productive. The poor people are dealing with diseases, medical debt, and shortened lives.
And here’s the cruel part: that advantage compounds. The people who can afford gene therapy today will live longer and earn more, which means they can afford more treatments as new ones become available. The people who can’t afford it now will get sicker, earn less, and fall further behind.
You could have a 55-year-old wealthy person who’s had five different gene therapies over their lifetime, competing against a 55-year-old working-class person who’s had none and is now developing heart disease.
This isn’t just about being born into the right family anymore. It’s about whether you can access life-saving technology throughout your entire life. And if you can’t, you fall further behind every year.
The Insurance Problem
Health insurance will break completely under this system.
Right now, insurance works because risk is spread across everyone. Healthy people and sick people all pay premiums, and the money covers whoever needs care.
But what happens when wealthy people can pay for gene therapy to eliminate their disease risks, while poor people can’t?
The wealthy people will have eliminated their risk of cancer, heart disease, Alzheimer’s, and other expensive conditions. They’ll rarely need major medical care. Insurance companies will want to charge them low premiums.
The poor people still carry all those genetic risks. They’ll develop those diseases and need expensive treatment. Insurance companies will charge them much higher premiums because they’re high risk.
So the people who can least afford high premiums will face the highest costs. And the people who could easily pay won’t need to.
This creates a death spiral: As more wealthy people get gene therapy and leave the regular insurance pool, premiums go up for everyone left. This pushes more middle-class people out. Eventually, insurance becomes unaffordable for anyone who hasn’t had gene therapy.
And if you can’t afford gene therapy and you can’t afford insurance, you’re stuck. You’ll develop preventable diseases with no way to pay for treatment.
The Dating and Marriage Divide
Here’s something nobody wants to talk about but everyone will be thinking about: dating and marriage.
If you’ve had gene therapy and eliminated your disease risks, do you want to marry someone who hasn’t? Your partner will likely get sick earlier and die younger. They’ll face medical expenses you won’t have. They might develop Alzheimer’s or Parkinson’s or heart disease while you stay healthy into your 90s.
If you haven’t had gene therapy, you’re now seen as a less desirable partner. Not because of your personality or character, but because you’re a health risk. You’re a potential financial burden. You might die 15 or 20 years before your partner.
Dating apps could start including “gene therapy status” in profiles. People will filter for partners who’ve had treatment. “Must be gene-edited” becomes a dating requirement, like “must be college-educated” or “must want kids.”
We’ll see people clustering—gene-edited people marrying gene-edited people, untreated people marrying untreated people. This splits society into two groups that barely mix.
And once that happens, the gap becomes cultural, not just medical. The gene-edited group develops its own social circles, neighborhoods, and expectations. The untreated group gets left behind in more ways than one.
Could This Actually Create a Better Society?
Let me play devil’s advocate for a moment. Maybe this isn’t all bad.
The great thing about gene therapy being available at any age is that it’s not a one-time decision at birth. If you’re 40 and develop Parkinson’s, and a gene therapy becomes available that cures it, you can get treated. If you’re 60 and at high risk for Alzheimer’s, and a preventive treatment comes out, you can still benefit.
This means the divide isn’t permanent the way a birth-only system would be. People can “catch up” as treatments become available and affordable.
If gene therapy becomes cheap enough fast enough, we could eventually treat almost everyone. It becomes like antibiotics or vaccines—something most people have access to. The total reduction in human suffering would be enormous. No more cancer. No more Alzheimer’s. No more children or adults dying from genetic diseases.
Healthcare costs would plummet. People would work longer, contribute more, and enjoy more years with their families. We’d add decades to human lifespan and eliminate most of the diseases that currently make old age difficult.
In that future, we don’t have two permanent groups. We just have humans who gradually gained access to better treatments. The untreated become a shrinking group as more people get access over time.
But that’s the optimistic scenario, and it requires gene therapy to become affordable quickly and for society to decide everyone deserves access. Neither is guaranteed.
The Question of What’s “Natural”
Here’s a philosophical problem: If we can edit genes to eliminate disease, should we?
Some people will say no. They’ll argue that editing human genes is “playing God.” That we shouldn’t interfere with nature. That being human means accepting our genetic inheritance, flaws and all.
Others will say that’s nonsense. We already interfere with nature constantly. We use antibiotics to kill bacteria. We perform surgery to fix broken bodies. We wear glasses to correct vision. Why is editing genes different?
If you can prevent your child from getting cancer, aren’t you obligated to do it? Isn’t it cruel to let your child carry a disease gene when you could have removed it?
But then where do you stop? If you can edit out disease, can you edit for height? For intelligence? For athletic ability? For physical beauty?
Once you start editing genes, the line between “fixing problems” and “creating advantages” gets blurry fast.
And that’s when the real divide happens—not just between enhanced and natural, but between enhanced humans with basic disease protection and enhanced humans with every possible advantage.
Three Possible Futures
Let me sketch out three ways this could go:
Future One: Universal Access. Governments decide genetic editing is a basic right. Every child gets it, paid for by taxes. After one generation, almost everyone is enhanced. The divide disappears. We become a healthier species.
Future Two: Genetic Segregation. Genetic editing stays expensive. Rich people get it, poor people don’t. Society splits into enhanced and natural groups. They barely interact. They don’t marry each other. After several generations, they’re almost separate species. This is the nightmare scenario.
Future Three: Partial Enhancement. Most people in wealthy countries get basic disease protection. Some people get extra enhancements if they can pay more. Some people refuse on principle. We end up with a messy mix of different levels of genetic editing, with constant arguments about what’s fair and what should be allowed.
Which future we get depends on choices we make in the next 10 to 20 years. Once a generation grows up genetically enhanced, it’s very hard to reverse course.
What About the People Who Can’t Afford Treatment?
Let’s think about this from the perspective of someone who simply can’t pay for gene therapy.
You’re 45 years old. You’ve just been diagnosed with early-stage Parkinson’s. There’s a gene therapy that could stop the disease from progressing. It costs $800,000. Your insurance doesn’t cover it. You don’t have that money. You’ll never have that money.
Meanwhile, your colleague at work—someone who makes the same salary but comes from a wealthy family—gets the treatment. Their Parkinson’s stops progressing. They keep working, stay healthy, enjoy their life.
You deteriorate. You have to quit your job eventually. Your medical expenses pile up. You become disabled while your colleague thrives.
You didn’t choose this. You worked just as hard. You’re just as deserving. You simply didn’t have access to the treatment.
This is the nightmare scenario: A world where your health outcomes depend not on your choices or your behavior, but purely on whether you can afford cutting-edge medical technology.
And unlike education or job training—things you can work toward—gene therapy might come too late if you can’t afford it when you need it. By the time it becomes cheaper, your disease may have progressed too far.
The Timeline: It’s Already Here
This isn’t far-off speculation. Here’s where we are right now:
- The FDA has already approved gene therapies that cure sickle cell anemia and certain forms of genetic blindness
- These approved treatments cost between $2 million and $3 million per person
- Scientists are in clinical trials for gene therapies targeting Parkinson’s, Alzheimer’s, heart disease, and various cancers
- CRISPR gene editing works and has been used on human embryos in some countries
- Within 5 years, we’ll likely have gene therapies for dozens of additional conditions
- Within 10 years, gene therapy could be routine for wealthy people across many diseases
- Within 20 years, the price might drop enough that middle-class people can afford some treatments
We’re not talking about the distant future. We’re talking about technology that exists today and is expanding rapidly.
The divide I’m describing isn’t hypothetical. It’s happening right now. There are people alive today who’ve been cured of sickle cell anemia through gene therapy. And there are people dying from sickle cell who can’t afford the $2 million treatment.
That’s the divide. And it’s only going to grow as more therapies become available.
The Choice We Have to Make
Here’s the bottom line: Gene therapy already exists. People are already being treated. The divide is already beginning.
The question is whether we let it grow into a permanent split between those who can afford genetic health and those who can’t, or whether we decide that access to life-saving gene therapy should be universal.
Do we make it available to everyone through insurance or government programs? Do we regulate prices so treatments remain affordable? Do we let the market determine who lives longer and healthier lives based purely on wealth?
Do we allow employers to discriminate based on genetic treatment status? Do we let insurance companies charge vastly different rates? Do we protect the rights of people who can’t afford treatment, or let them face the consequences?
These aren’t easy questions, and people will disagree passionately. But we need to have these conversations now, while the divide is still small enough to address.
Because once millions of people have had gene therapy and millions more can’t afford it, the gap becomes very hard to close. The people who benefited early will fight to keep their advantage. The people left behind will grow resentful. Society fractures along genetic lines.
That future could be a world where we’ve eliminated most disease and extended healthy lifespan for everyone. Or it could be a nightmare where wealth determines not just your opportunities but your literal genetic health, and that gap compounds across generations.
The technology exists. The treatments work. The only question is whether we distribute them fairly or let them become another advantage for the wealthy.
And unlike many forms of inequality, this one affects the most fundamental thing: your health and how long you live.
We have maybe ten years to get this right before the patterns become permanent.
Related Articles:
FDA-Approved Gene Therapies: Current Treatments and Costs
The Ethics of Gene Therapy Access and Affordability
CRISPR and the Future of Genetic Medicine
