Modern welfare states offer cash payments, public housing, medical assistance, food subsidies, and a wide range of social services to needy individuals. The assistance is rendered by professional social workers and administrators who have the authority (and responsibility) to determine who is needy, what their needs are, and how those needs can be met equitably and efficiently. This top-down approach is both ineffective and paternalistic, according to Julie Anne White, who advocates a system of care based on democratic delib- eration rather than bureaucratic rationality.