Question special

Building on Dr. Usani's comment, International Medical Graduates (IMGs) are often hit hardest by the cost of licensing exams. Even before their greater travel costs, the actual test costs IMGs $1,535 (vs. $1,275 for US medical students). Step 2 CS grew out of the Clinical Skills Assessment, an exam previously given just to IMGs to assess English-language proficiency and clinical skills. Part of the reason provided for the decision to expand to Step 2 CS to include all US Medical graduates was one of fairness -- to create an even playing field for US and IMGs. Given this history, I have 2 questions:
1) Is there a better (more discerning, cost-effective) way to assess IMGs on the domains covered by CS (Communication and Interpersonal Skills, Spoken English Proficiency, and Integrated Clinical Encounters) given the variation in quality, style, and culture of medical practice internationally?
2) Is it unfair to exempt US medical graduates from Step 2 CS if they have passed a clinical skills exam at their licensed US Medical School? Why or why not?