I think more having the modified AST feed back into the source code, or more accurately, the human-readable view of the actual source code. Like the comment example - imagine having the monkeypatch still in the comments module, but when you open the WallPost class, you can see the "has_many :comments" and a tag that takes you to the comments functionality.
Alternately, you can do the the reverse - someone writes the change in the more traditional manner, but you can view - and edit - the change-set as if it were a module of monkey-patches isolating the relevant concerns. Or any particular view of the program someone can think of that's useful.
I'd like to program like that.
ETA - Sorry for the accidental downvote; found a couple of your other comments to upvote.
Yes, like any modern high-level language it would use some concepts "borrowed" from LISP. Credit where credit due...
On the other hand I don't want to go completely bananas with the 'structureless' LISP. In my opinion at least it would aid comprehension to be mirror modern high-level languages. But you'll be able to choose Ruby or Python syntax-mode at will (or maybe even LISP-mode :-).
You mean like in LISP?