Understanding that enhancements are specific, often double-edged changes—beneficial in some settings for some purposes but not in others—suggests that a better analogy here may be the governance of health care itself. Good health care on the one hand and power, wealth and status on the other are positively correlated, through the expanded opportunity range that meeting specific health needs can provide. That correlation helps support the case for equitable access to health care. But not all health care needs are equally “profitable” in leveraging other social goods, and it is not the goal of a needs-based health care system to address that disparity. Just as a fair system of health care should be able to provide need-based access to specific therapeutic interventions, a fair biomedical enhancement allocation system should be geared to needs of people facing particular life challenges. In fact, in the end, as this tour of the enhancement literature suggests, with sufficient renegotiation of the boundaries of health care, it could be the same system. Again, the task of realizing such a system will continue to be daunting. But it is doubtful that this will require a Brave New World of centralized global moral enhancement schemes: instead, managing our emerging biomedical enhancement abilities begins with the tedious real world tasks of learning to live with human difference and meet human needs.