The worst hereditary afflications take care of themselves, without a totalitarian government.

We have several choices, and some are obviously more beneficial than others:

1) Go back to a primarily capitalist society. Give freedom, with its benefits and its burdens.

2) Stay with a pseudo-capitalist / pseudo-socialist society that is willing to tolerate the cost of non-producers. Try to moderate the burdens of freedom without collapsing society as a whole.

3) Move to a totalitarian society to centrally manage these issues, for the benefit of society as a whole, at the expense of the individual and the family.

I prefer 1 or 2. I'd fight against 3. I don't think you can control procreation in any way without going to option 3.