Arthur Kellermann, associate dean for health policy at Emory University, stated rationing by ability to pay rather than by anticipated medical benefits in the U.S. makes its system more unproductive, with poor people avoiding preventive care and eventually using expensive emergency treatment.Ethicist Daniel Callahan has written that U.S. culture overly emphasizes individual autonomy rather than communitarian morals and that stops beneficial rationing by social value, which benefits everyone.