The Dish

Harold Pollack explains how Medicaid forces millions of people with disabilities to live in poverty in order to remain eligible:

With important variations across the states, most recipients are forbidden from having more than two or three thousand dollars in the bank. You can generally keep your house or your car. That’s pretty much it. You can’t have that emergency fund on hand in case the muffler or the furnace breaks.

And what about the stuff Medicaid doesn’t cover? It’s nice to get your teeth cleaned or just to buy a Big Mac every once in awhile. Because of such means-testing, that new mother is forbidden from setting any money aside for her child’s education. That food services worker living with intellectual disabilities can’t save up for a nice vacation. …

These requirements seem especially strange in the wake of health reform. If you’re on Medicaid because you had a spinal cord injury, you face punishing limitations on your allowable financial assets. If you qualify for Medicaid on the basis of low-income, you don’t face the same limitations. There’s no real justification for this inconsistency. Its one virtue may be that it could prove politically generative, in promoting beneficial reforms. It’s hard to believe that the disability community or the American public will long tolerate this discrepancy.

The 2013 Achieving a Better Life Experience (ABLE) Act, which is on the legislative agenda again this year, is intended to mitigate this catch-22.

Sarah Kliff explains why the Beaver State is shutting down its health exchange:

Oregon’s exchange has, since the get-go, had a pretty terrible run. Because of technological problems, the state couldn’t process online applications for months. Instead, it had to hire 400 temporary workers to process the flood of paper applications used as an alternative. And even by the end of open enrollment — and after spending $200 million in federal funds — Cover Oregon was the only exchange in the country where people couldn’t self-enroll in a health plan in a single sitting.

Oregon’s exchange didn’t have one single-point of authority, a state-issued review concluded in March. The project involved multiple agencies, who sometimes had different and conflicting goals. And Oregon did not set any penalties for when its main contractor, Oracle, missed deadlines.

This raises a number of policy questions, as Jason Millman points out:

Despite its technical problems, Cover Oregon has enrolled about 64,000 in private health plans since October, and enrollment has been extended until the end of the month. When the next enrollment period opens Nov. 15, will those Oregon customers have to go through the enrollment process all over again? That’s not clear, Cover Oregon technology chief Alex Pettit said Thursday. He’s scheduled to meet with federal health officials Monday and Tuesday to iron out further details.

Suderman’s lays into the state government for its incompetence:

Cover Oregon didn’t come through it at all. There were delays, and then more delays. The exchange never successfully went online. No one ever signed up for private coverage through the system. Reports surfaced showing that independent consultants had warned for years that the ambitious project was likely doomed. The warnings were ignored.

In March, Gov. Kitzhaber accepted the resignation of Cover Oregon’s acting director Bruce Goldberg, who supervised the exchange-building process, and requested that the exchange’s board remove Chief Operating Office Triz DelaRosa and CIO Aaron Karjala. It was a $300 million disaster—a model for the nation that turned out to be a total failure.

Josh Archambault predicts that several other state exchanges will fail eventually:

[A] recent hearing in DC highlighted how many of the states still lack a plan to sustain operations in the coming years. All claimed to not require additional federal funding, but even the executive director of the California exchange had to push back on independent assessments that they would be unable to sustain in future years. Hawaii was of special note, given that they don’t have any concrete plans for how to finance themselves yet.

The Obama Administration has started to show malleability in how long states have to spend establishment funds, Rhode Island being the first example of this. But those funds will eventually run out, and a GOP-run Congress is unlikely to provide a blank check to keep them running.

Esther Breger criticizes ABC’s new medical drama “Black Box,” about a neuroscientist with bipolar disorder, for perpetuating the trend of treating TV heroes’ mental illnesses as superpowers:

Catherine, the medical director of a fancy neurological center known as the Cube, is apparently amazing at her job, and “Black Box” doesn’t hesitate to draw a connection between her genius and her illness: “Catherine has an insight into her patients that no one else has, allowing her to communicate with them on a different level,” according to ABC’s press notes. She’s fabulously empathetic and intuitive, somehow able to see what all the other doctors miss (though her cases should be familiar to anyone who reads Oliver Sacks’s essays). That’s because, the show keeps reminding us, mental illness goes along with greatness. …

The show’s particular absurdities are all its own, but “Black Box” is part of a long line of fictions that treat psychological disorders as a professional asset.

On TNT’s “Perception,” which will soon air a third season, Eric McCormack plays a schizophrenic neuroscience professor who moonlights as an FBI consultant, solving murders with the help of witnesses he hallucinates. “Mind Games,” which lasted five episodes this spring before getting the axe, starred Steve Zahn as a bipolar genius who used to teach psychology and now runs a “problem-solving” business. Benedict Cumberbatch’s Sherlock Holmes coolly calls himself a “high-functioning sociopath,” but Sherlock fans have been offering competing psychological profiles for Arthur Conan Doyle’s character for decades. “Homeland,” at its best, complicated this dynamic, but Claire Danes’s Carrie Mathison was still gifted with a perception that her saner C.I.A. colleagues lacked. She was a superhero, until she was a lovesick lackey.

Because it’s so painfully clumsy and thoughtlessly constructed, “Black Box” distills what’s unsettling in the rest of these shows into something wholly unpleasant.

Alan Sepinwall also pans the show:

Describing the show makes it sound like the sort of thing Jack Donaghy might have scheduled on the “30 Rock” version of NBC: Kelly Reilly plays Catherine Black, a brilliant neurologist who’s known as “the Marco Polo of the brain,” and who has somehow kept secret from all her friends, colleagues, and even her long-term boyfriend Will (David Ajala) that she is bipolar, and subject to abrupt, extreme mood swings from manic to depressive. Her name is Black, she tells us that people in her field call the brain a black box, and she is an expert at curing everyone’s neurological difficulties except her own! And she frequently refuses to take her medication because she fears becoming dull or, worse, “normal,” which leads her to sleep around, perch on hotel balcony railings while drunk and frequently dance to free-form jazz compositions that only she can hear.

In other words, it’s combining what’s become the most annoying aspect of “Homeland” with the most formulaic parts of “House”(*) with that tired old saw that Fienberg has dubbed the Vocational Irony Narrative.

Gobry argues that conservatives ought to agree with Piketty’s proposal to shift the tax burden from income to wealth:

To be a conservative is to want a vibrant, innovative economy. All else equal, presumably, in order to have such an innovative economy, you want to have risk-taking and risk-bearing capital. The problem with the global economy isn’t, per se, that the rich have a lot of money. It’s that the rich have a lot of money and, instead of investing it in rocket ships to the moon and dotcom ventures, almost all of them are instead investing it in government bonds and ultra-safe corporate bonds. With inflation at zero and no wealth tax, investing at 2% for no risk is very attractive. If there is inflation and/or a wealth tax, suddenly you have to seek it out bigger investments.

Looked at it very broadly, the conservative “diagnosis” would say something like this: for the broad middle class, what we usually think of as the components of “the good life”, i.e. housing, a job, affordable healthcare, higher education, and so on, are growing increasingly expensive–and in large part this is because of bad government regulation. This is also true of access to capital. As Piketty says, all else equal, we want to increase wealth mobility and access to capital.

Noting that Americans see Piketty as more left-wing than he sees himself, Yglesias points out that he actually wants to cut most Americans’ taxes:

Piketty’s big point about the United States is that we actually do engage in substantial wealth taxation in this country. We call it property taxes, and they’re primarily paid to state and local governments.

Total receipts amount to about 3 percent of national income. The burden of the tax falls largely on middle-class families, for whom a home is likely to be far and away the most valuable asset that they own. Rich people, of course, own expensive houses (sometimes two or three of them) but also accumulate considerable wealth in the stock market and elsewhere where, unlike homeowners’ equity, it can evade taxation.

Piketty also observes that the current property tax system is curiously innocent of the significance of debt. A homeowner is taxed on the face-value of his house, whether he owns it outright or owes more to the bank than the house is worth. “If you own a house worth $500,000 but you have a mortgage of $490,000 then your net wealth is $10,000,” he explains. “So in my system you would owe no tax.”

But Scott Sumner thinks we should measure inequality not by income or wealth, but rather by consumption:

[T]here are plenty of billionaires who splurge on things like 500-foot yachts. Now we are getting somewhere! The labor and materials that went into constructing that yacht could have produced 10,000 cars for average people. That sort of inequality is real. That’s what we (should) mean by “economic inequality.” That’s the way all of us economists were taught, but 99% of us seem to have forgotten what we learned about consumption. Consumption is what you should tax. Of course when we tried to do that a bunch of Democratic politicians who have apparently never heard of Bastiat said the luxury tax was a bad idea because it cost jobs in the yacht making industry. (I’m not joking.) Nor are they willing to cut back on intellectual property protections for companies like Disney.

Capital in the Twenty-First Century is available here.