Some do, for example I recall a conversation with my uncle about engineers who were designing and manufacturing lifts/elevators.

But I wonder how much "smarts" and "skill" has to do with it vs being a key player in the "current" industry in the eyes of the state.

Tech is currently the top tier in the west, and lets be fair, the US extracts all the value between its insurance and medical bills circle jerk. A perfect system to draw money from the printer and yet rush it past the patients, doctors, the hospital and pretty much anyone but the financial middlemen.