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> Nothing good comes from exempting smart people from having to think 
> about and account for their actions, or encouraging them to ignore the 
> realities of limit and hard choices. In-or-out schemes fail the tests 
> of logic and justice. Getting rid of them would signal a commitment to 
> fairness and recognition that arbitrariness gets in the way of good 
> and efficient care. It would broaden system stewardship and bring 
> providers into the deliberative fold. It would require people to think 
> more deeply about value for money, and to be more transparent in and 
> accountable for their decisions. It would give providers the freedom 
> to seek creative solutions to complex patient problems, along with the 
> responsibility to give reasons for what they do. If we really want a 
> more accountable, just and unified healthcare culture, it's a great 
> place to begin. 

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