It seems clear that if you just take a distribution from previous years and lay them on top of a ranking, you are creating a lot of problems. And you are hiding your incentives on the penalty function, which is something he mentioned. People have correctly figured out that a good kid at a bad school will not be found, and that the marginally second best kid in a year is going to get marked down.
Whatever you think of exams, and I'm no fan, they do give people that mix of noise and signal that society needs to put to rest the issue of who deserves what. They're not entirely a lottery, not entirely skill or hard work, but if we need a way to distribute X number of future doctors, that's the long established way to do it.