Ensuring Universal Access to Enhancing Technologies

One of the most troubling challenges for technoprogressives is how we can ensure universal access to safe technologies in our deplorably unequal world. Sadly there is no guarantee that any particular desirable technology will become available to all, within decades or ever.

Sewers, running water, electricity, telephones and books have been around for a century and still aren’t available to a substantial fraction of the world’s population. The inexorable working of market competition has churned away, and still those fruits of modernity, not to mention penicillin, organ transplantation, and so on, are not within the budget of families with an average annual income of $300/year.

Nano-magic will make everything trivially cheap, and super-abundance eliminate all acquisitiveness and poverty? I doubt it, so long as we still have laws protecting intellectual and physical property, and governments to back them up. Someone will still own the patents on the nano-replicators, and the replicators themselves, and the software and raw materials and energy and tech support that make them work. So long as those people extract maximal profit for their ownership of these means of production, then some percent of the world’s population will be priced out of access to whatever the replicators make.

Looking at the history of access in the last century we can predict that there will be at least three categories of emerging technologies requiring three different approaches to ensuring their universal access:

First, there will always be some public goods which require public investments to develop and provide the optimal level of. When we try to provide a public good through the market we don’t get enough of it, because the costs are too high for individual consumers, and the benefits are enjoyed by all. The classic case is defense. As attractive as dismantling the military apparatus might be, individuals contracting with the local private defense firm to keep their homes safe against weapons of mass destruction doesn’t work well for the individual, much less society.

So what kinds of emerging technologies, especially enhancement technologies, might be public goods? Basic health, longevity and ability for the population is a public good, which is why all rational societies provide universal health care through public expenditures. As the United States demonstrates, relying on the private market for health care not only wastes enormous amounts of money on administrative overhead and irrational priorities, while leaving 44 million Americans without health insurance, and in poor health. Their health costs are then a drag on society through the rise of infectious diseases, and their reduced productivity. 

If there was a gene therapy that cost a year’s income, but provided an additional decade of healthy life expectancy, some citizens might purchase it but not all would. It would make sense for society to provide such a therapy through public expenditures since it is a rational investment for society, even though many individuals might not see it as an individually rational thing to do.

A second category of technology will be stuff which starts off cheap and safe and marketable, like aspirin. This kind of technology needs some public expenditure to ensure its safety, and some expenditures to ensure access for the poorest, but otherwise can be left to the marketplace.

The third category are technologies which start off prohibitively expensive for any but the wealthiest. Over time the market and technological innovation will probably make most of these cheaper and more widely accessible. But, as with organ transplantation, there is no guarantee that it will become cheaper, and there is an urgent humanitarian rationale to use public policy to speed up universal access.

An example here is anti-retroviral drugs for HIV which have gone from $40,000 per year in 1995 in New York City, to $300 per year in 2007 in Botswana. That required:

• hundreds of millions of dollars of public research monies to develop the therapies
• hundreds of millions of dollars of public monies to provide the therapies and evaluate their efficacy
• an international campaign to support universal access to anti-retroviral for the world’s poorest
• threats by Brazil, South Africa and India to abrogate Big Pharma patents, which eventually led to agreements for lower cost sales of the drugs in the developing world
• research to reverse engineer low-cost versions of the drugs
• the establishment of the Global Fund for HIV, Tuberculosis and Malaria to subsidize access for the world’s poorest.

As a consequence of these initiatives about 10% of those with HIV in sub-Saharan Africa now have access to anti-retrovirals.

So what potentially stands in the way of universal access to enhancing emerging technologies?

- capitalism and private enterprise
- property law
- government investment and provision

What will ensure universal access?:

- capitalism and private enterprise
- property law
- government investment and provision

And no, just talking about it, or insisting that the market, Friendly Robot God-Kings, or the industrial working class will inevitably take care of it will not ensure that it happens.