 Fourth, above the decent welfare minimum, it is unlikely that access to the some broader insurance package is prudent for all people to buy. That is the reason Gibbard says it is not equitable to require equal access to all health care. Here equity is equated with ethically acceptable, and what counts as ethically acceptable is (among other things) what is endorsed by the Ex Ante Pareto Principle. The same principle shows that some kinds of care are not prudent for anyone to buy—prospects are better for all people if they do not buy insurance for that care—and so a defense is made for some implications of cost effectiveness analysis.