The Black Io Chronicles.

The Economics of Cyberware

In cyberpunk, implants and high-tech prosthetics are practically a given. And because it’s cyberpunk, the characters sporting those shiny augmentations are often the down-and-outers least likely to afford them - back-alley mercs, hackers-for-hire, thugs, anarchists, and worse besides.

It’s a disparity that reached a kind of beautiful, absurd zenith in FASA's Shadowrun RPG, where you used to be able to crank out chromed-up street samurai with a million dollars’ worth of body augmentation and a flophouse apartment, subsisting on nothing but cheap ramen and desperation.

It’s something that always bugged me about the genre, to be honest. But when I yammered about sci-fi world building a few weeks back, I also advised people to think through the implications of new technologies in their fiction. “You’re not just making your world more plausible," I argued, "but you’re pulling up new stories and potential narrative twists in the process.”

So rather than just dumping all over the concept of hobos with military-grade cybereyes, I decided to “walk the walk” and take a (mostly) serious look at the economics of cyberware - and what it might mean for speculative sci-fi.

How expensive would a high-tech prosthesis be?

While we can’t exactly price out full-blown cyberware just yet, recent advances in prosthetic technology give us an idea of what a cyber-limb might eventually go for. Here’s a few examples:

On the simpler end of the spectrum, the high-end carbon fiber running blades used by disgraced Paralympian (and double amputee) Oscar Pistorius cost about $18,000 a pop back in 2007.
Bebionic, an artificial hand controlled by myoelectric sensors, was priced at about $11,000 when it was released in 2010.
Meanwhile, a “bionic arm” currently in development at Johns Hopkins, which is capable of being controlled by the brain (and is the closest thing we currently have to honest-to-god cyberware), is expected to cost up to $60,000 once it hits markets.
Proper bionic legs are similarly pricey; one “military-grade” model developed by German company Otto Bock came out to $95,000 in 2011. A more sophisticated, thought-controlled design currently being evaluated has yet to be priced out.
Other kinds of would-be cyberware do even worse - Argus II, the world’s first retinal prosthesis, costs a staggering $115,000, with clinical trials alone adding up to $1M per test subject.

None of this is exactly chump change - in fact, you can buy some pretty nice sports cars for that kind of money. And these are just “basic” models by cyberpunk standards: no frills, no hidden guns or blinged-out golden flame decorations.

What about other costs?

Material and device costs aren’t the only expenses you’d incur with cyberware. Modern prosthetics are generally designed to be pulled on or off with relative ease; cyberware in popular fiction is usually grafted directly onto the owner’s body. That means surgery - and as anybody who’s ever looked at a medical bill can attest, that’s something that gets costly in a hurry.

Depending on what - and how much - you’re installing, surgical costs would start in the tens of thousands and work their way up from there. For example, a cochlear implant, a “bionic ear” that treats hearing loss by directly simulating the auditory nerves, currently costs between $40K to $100K to install, though this also covers the cost of the device itself, as well as pre-surgery evaluation and rehabilitation after the procedure. And if you want to go the full Johnny Mnemonic and get a computer implanted into your brain, brain surgery in the US runs somewhere between $50 - $150K out of pocket, depending on where you have the procedure done.

For the well-off or well-insured, that’s not a speed bump. In fact, insurance companies actually have good reason to cover the expense of a high-end prosthesis - even at $100K+, such devices can still be significantly cheaper than the cost of care and rehabilitation for the conditions they’re intended to treat.

But if you’re uninsured - or cash-shy - it’s a very different story. (And let’s face it: even the most generous insurance isn’t going to spring for those badass Wolverine-style claws in your knuckles.) For cyberware to be as ubiquitous as it is in your average cyberpunk piece, Joe and Jane Average should be able to afford it out of pocket. And if a single cyber-limb costs more than most people’s average annual income, that’s simply not going to happen.

But wouldn’t the cost of prosthetics go down over time?

Potentially. It’s a reliable rule of thumb that things get cheaper as production processes become more efficient. However, for that to happen, there has to be enough demand to justify a switch to streamlined, large-scale manufacturing.

And at the moment, demand isn’t really all there, at least where limb replacements are concerned. A 2006 report by NIST (PDF File) estimated that there were just shy of 2 million amputees living in the US, with an additional 185,000 amputation surgeries performed each year. The major cause of limb loss? Diabetes and vascular disease, which accounted for a whopping 82% of all amputations.

Globally, the numbers aren’t much better - you’re looking at about 10 million amputees out of a population of 6.7 billion (PDF File). That’s a lot of people without hands or limbs, but still not enough to spark a serious push for high-quality and affordable replacements - let alone the dizzying range of add-ons and knick-knacks you see in your typical cyberpunk RPG. After all, why bother developing a special limb with on-board USB drive and retractable elbow katana when there’s barely enough of a market for a vanilla prosthesis?

On the other hand, things like eye implants are far more likely to benefit from economies of scale - the WHO estimates 285 million people globally have some form of visual impairment, with another 39 million out-and-out blind. The tradeoff is that these implants are also a lot more expensive and complicated to install - even if they do reach a point where mass production becomes feasible, they’d probably still present a substantial investment.

With all that said, there are a couple of other ways the average cyber-crusty could get him- or herself chromed up in that rainy near-future dystopia.

[Image by cryoclaire.]

Scenario 1: Growth in Demand

The variety and affordability of cyberware in popular fiction suggests a large, thriving market for such products. What could create these kinds of market conditions?

The most obvious possibility is an uptick in medical necessity. More amputees in the system means more people needing replacement limbs, and bigger incentives for companies to crank out more affordable products. Problem is, there aren’t that many things that would actually lead to a dramatic increase in limb loss.

You’d think combat injuries would be a great way to spur cybernetic development - after all, the Department of Defense is throwing tens of millions of dollars at the problem. But veterans make up a surprisingly small portion of the amputee population - that same NIST report I cited earlier also claims the American Veterans’ Administration (VA) has just 40,000 of them in its (admittedly awful) system. And that’s the sum total of every war the United States has been involved in since World War I.

As for the civilian victims of conflict, exact numbers are difficult to come by. But Cambodia, which might have almost as many unexploded landmines as it does people, still only had an estimated 40,000 amputees out of a population of 11.5 million.

A more likely scenario might be a rise in medical amputations stemming from a large-scale outbreak of bacterial strains with antibiotic immunity. Bacterial infections already lead to amputation in a variety of circumstances, so throw in an untreatable super-strain, and you might actually see enough demand to create a proper population of cyberboys and -girls. (Added bonus: this kind of medical horror feeds nicely into the dystopian themes of most cyberpunk settings.)

It’s also possible that we’ll see a growing number of people decide that they want to swap parts of their body out, medical necessity be damned. After all, we already have self-experimenters like Kevin “Captain Cyborg” Warwick, Moon Ribas, and Lepht Anonym pushing at the possibilities of human modification.

Would there be enough of these transhumanists to actually support a full-fledged cybernetics industry, though? It’s kind of a long shot, especially when you consider the permanent, transformative nature of cyber-surgery. Google Glass may turn you into a poor man’s cyberpunk, but you can still take it off at the end of the day. Voluntarily hacking bits of your body off - even in the name of self-improvement - will be a little too drastic for that true mass-market audience.

Scenario 2: The Installment Plan

The alternative to making cyberware itself cheaper is to reduce the amount of money people pay out of pocket for those implants. That means looking at potential financing options for such products.

Let’s dive back into the “cyberlimb as sports car” analogy for a second, because the parallels actually make a lot of sense. When you buy a car, you aren’t going to be paying the full sum up front unless you’re, y'know, a millionaire rapper.

Similarly, that $60K arm might not be something you pay off all at once. Instead, users who can’t get their insurance to cover the costs might be put on a monthly payment plan - a kind of “cyber-mortgage”, if you will.

If so, this opens up a host of interesting follow-on questions: what happens when you miss a payment? Is it possible to repossess an implant after it’s been installed? Would we see the emergence of scammy “payday cybernetics” with financing plans designed to squeeze terrifying amounts of money out of newly-minted augments?

Scenario 3: Going Cheap

Of course, sports cars aren’t the only vehicle on the market. Most of us can’t afford a Bugatti Veyron, but a Ford Focus also gets us from A to B in reasonable comfort.

By the same token, there’s plenty of scope for cheap, simple cybernetics that may not be able to turn into a machine gun, but will still let their owners have some semblance of a normal daily life. These would look something like the JaipurKnee, a $20 plastic prosthetic designed by a team out of Stanford University specifically for the developing world. Glamorous? No. But for slum dwellers and crusties, it’s a far more viable - and realistic - option.

[Image by cryoclaire.]

Scenario 4: “Other Sources”

Up until now, we’ve been assuming that you’re getting your implants and augmentations through legal channels. Shady back-alley clinics - another beloved staple of cyberpunk - could keep those dizzying surgical costs down, but might come with their own sets of risks.

If the demand is there, it’s also easy to see a gray market for second-hand cyberware - or pieces outright stolen from their original owners. It’s just as easy to see manufacturers attempting to counter this by introducing anti-theft devices or countermeasures that kick in when a limb is removed from its original owner. Getting an implant would be the least of your worries, then - the real challenge would be “jailbreaking” it prior to installation.

The key word here is “if” - the overall market for cybernetics still needs to be large enough to support - and justify - such activities.

Scenario 5: DIY

Finally, with the rise of 3D printing and the resurgence of “artisan culture”, enterprising cyberpunks could get their ‘wares by downloading instructions off the internet and assembling the pieces in the comfort of their own homes. This isn’t much of a stretch, either - we’ve already seen people do this in the real world, often under extremely challenging circumstances.

The one problem is that this only addresses the hardware side of the equation - actually hooking up those homebrew creations is another matter entirely.

Summing Up

Fun as it is, it’s unlikely that we’ll ever see a future where even dive bar owners sport space-age polymer arms capable of punching a truck in two. While technology will continue to improve in both quality and affordability, truly cutting-edge implants will probably still be restricted to the wealthy and well-connected, or government-funded (read: military) projects.

But even in a realistic cyberpunk setting, there’s scope for prosthetics and augmentations of all shapes and sizes - and as I’ve hopefully demonstrated, plenty of interesting stories to be spun out of how their owners came to acquire them.

Special thanks to cryoclaire for letting me plunder her archives for this piece. Thoughts? Comments? Send me an ask - I’m always happy to hear from readers.