Health bill threatens to bankrupt man

A year ago, Tom Carlo's back was killing him. And now it's simply threatening to send him into bankruptcy.

Carlo, 63, has struggled for more than 40 years with back pain, since falling out of the second floor of an Air Force barracks in 1968, when his unit was under attack in Vietnam. Last spring, he was unable to sit for very long because of the pain, and he was taking drugs that were wrecking his stomach. He opted for a spinal surgery -- his third -- recommended by a doctor.

The surgery was supposed to lead to a cure from pain, and Carlo has found some relief. But his financial problems were just beginning. In June, his insurance carrier, CareAllies, OK'd the operation. In July, Carlo checked into Winthrop-University Hospital in Mineola. In August, CareAllies reversed its decision and denied payment to the two surgeons who operated.

"When the insurance company gives you the OK, you figure, let's do it," Carlo said. "Two months later they told me I should have tried physical therapy or shots -- well, it's too late now."

This is an unpredictable moment in the business of medicine, with costs soaring, the federal government rewriting rules, and insurance companies and doctors vying for some control over the inevitable changes. But people like Tom Carlo, a retired U.S. Postal Service letter carrier who drives a school bus in Garden City, shouldn't have to bear the brunt of these tectonic shifts. He appears to be caught by an insurance carrier balking at astronomical fees from an out-of-network doctor.

New York, unlike other states such as New Jersey, doesn't have a law against excessive billing.

CareAllies, a unit of Cigna, provides health services under contract to the National Association of Letter Carriers. Carlo's plan is a PPO -- a preferred provider organization -- which supposedly gives him the freedom to shop around for a surgeon, provided he shoulders a greater share of the bill. PPOs often pay 70 percent of the "usual and customary" costs of out-of-network care.

The whopper surgeons' bills may have had something to do with CareAllies' change of heart. The primary surgeon billed $355,000, and the assistant surgeon $160,750. Enough to pay for Carlo's tidy Wantagh house and then some.

He has appealed the decision up the chain to the U.S. Office of Personnel Management, which is ultimately responsible for the letter carriers' insurance contract. A representative of that office didn't return phone calls for this story. In a letter to Carlo, CareAllies said that his records had been checked as part of a random audit, and that an independent reviewer had determined the surgery was not medically necessary. Winthrop Hospital and Cigna said they will look into Carlo's case.

In Nassau County, the "usual and customary" rate for this surgery would have ranged between $49,750 and $64,750, according to Empire BlueCross BlueShield. Dr. Scott Breidbart, Empire's chief medical officer, said that out-of-network billings are an area of heated dispute between insurance companies and doctors.

Normally, the insurance company and the doctor would try to negotiate. But Carlo has been appealing CareAllies' decision for 10 months. If the Office of Personnel Management denies his claim, the next resort will be to sue in federal court -- an exhausting and expensive prospect.

Carlo's tale isn't unique. Medical expenses are a leading cause of bankruptcy. But it's an example of why we need health care reform. It doesn't get much worse than having a $515,750 bill dumped in your lap.

First published in Newsday

Home-sharing's time returns

Pushed along by those twins of the Great Recession -- unemployment and foreclosure -- America may be moving back under the multigenerational roof.

At a recent reunion of high school friends, I talked to one who had returned to her mother's house, along with her brother and sister. The whole family was back together again, this time with grandchildren added to the mix. It was a disaster. The siblings were fighting as much as they had in high school.

Another friend's son was enlisting in the Army to avoid moving back into her home after graduation. The Census Bureau says that 54 million Americans were living in multigenerational families in 2010, up from 49 million two years earlier. That's the highest count since 1968.

Of course, it's nothing new for large extended families to live under one roof. In many parts of the world, it's the norm. In this country, Asians and Hispanics have higher rates of multigenerational living, perhaps reflecting greater cultural acceptance.

But for the most part, since the 1950s, the American middle class has assumed that one is up and out at 18. Each nuclear family, according to this standard, had its own home.

And that attitude can make moving back in together -- or "doubling up" in demographers' terms -- feel like a step backward. It can be a sign of financial desperation, a response to unemployment, lack of child care or health care, or affordable rents.

But there are many advantages that generations can offer one another: care-taking for the young or old, emotional support and the sharing of life lessons. Those benefits -- as well as the financial considerations -- are what led the Huntington-based Family Service League, a social services agency, to create its HomeShare program, which matches older adults with someone who could use their spare bedroom.

Artist Milton Colón, 47, heard about the program through Fountainhead Church in East Northport. He is sharing the Smithtown home of Meinhard and Aino Joks, who are 86 and 85. Colón does the laundry, cooking, bed-making and errands, allowing the Jokses to stay in their home even though their home health care benefits have run out.

In turn, the Jokses have given him shelter and stability. Colón's wife of 22 years died in 2008, of an accidental overdose, and he fell apart. He began living out of his car.

While she was alive, Colón had made a living painting portraits. He was as busy as he wanted to be -- before the recession drained his Brentwood business of customers.

The Jokses are from Estonia and Finland and tell him stories of their emigration after World War II. "I'm a World War II history buff," Colón says. "So, that's something we share. I love history. I could take it in all day."

In the evenings, he works at a basement desk on a comic strip that he's developing. It's about a proud Puerto Rican father named Flores who moves his family from Brooklyn to the suburbs -- "Flowers in Blue," Colón's own story. His new home with the Jokses not only tethers him back to family life, it gives him an artist's freedom from financial worries.

That's the facet of multigenerational living that is not often expressed. We all know about the tensions and bickering -- the fall from the ideal after having somehow slipped off the path to the single-family home. But there is sweetness, too.

So why not make the best of what, for some, has become the new American reality? With 8.8 percent unemployment and 2.36 million homes foreclosed by banks between 2007 and 2010, the middle class is struggling. Independent living may be an American value, but so is helping each other through hard times.

First published in Newsday

Shriver launched a Peace Corps that broadened Americans' lives

Although it's been more than two decades, I remember very clearly how nervous I was before stepping out onto the streets of Togo, West Africa, as a newly minted Peace Corps volunteer.

At dinner during our first night in the wet sub-Saharan country, we 40-some volunteers were dining on avocado halves when the lights went out. As our hosts worked to start the backup electrical generator, the sudden darkness jarred me into thinking how far out of my element I was. What if the Togolese were nothing like the people I had known back in my insular, white Massachusetts suburb? What if they were completely alien? I felt a little panicky.

But the lights came back on. I picked at my avocado, and the following day I began a journey - making many good Togolese friends and learning valuable lessons about the universality of human frustrations, dreams and endurance.

Sargent Shriver, the man whose leadership made that journey possible for me and more than 200,000 other Americans, died Tuesday at 95.

President John F. Kennedy launched the organization in 1961, as a way of introducing Americans to the rest of the world. He thought that our reputation abroad was "ugly" and arrogant. In his inaugural address, given 50 years ago today, Kennedy reminded us that we were in the historic position of being able to abolish all poverty or abolish all life.

"To those peoples in the huts and villages across the globe struggling to break the bonds of mass misery, we pledge our best efforts to help them help themselves, for whatever period is required," Kennedy said. "If a free society cannot help the many who are poor, it cannot save the few who are rich."

Shriver, a former Kennedy family employee married to the president's sister, Eunice, was named the Peace Corps' first director. The organization helped Americans grow from our insular 1961 world into the globally engaged nation we are today. The Peace Corps took us by the hand on that adventure. It provided a way to see the world for middle-class people - those who could afford to take a couple of years away from establishing their careers, but wouldn't necessarily be able to travel otherwise. It was an outlet for the tumult of the 1960s, growing quickly to 15,000 volunteers serving in more than 44 countries by 1966.

In the 1980s, President Ronald Reagan first cut, then expanded the Peace Corps. The organization has been embraced by Democrats and Republicans alike, with George W. Bush and Barack Obama among its strongest supporters.

Shriver could have settled for Kennedy's original vision of sending some nice, young Americans abroad to charm the Third World. But he insisted on technical skills from the Peace Corps' early days. And he extracted a pledge from every volunteer to not only help host countries meet their needs for trained men and women, but to return to the United States to, in turn, bring the world to Americans.

Former Mali volunteer Anne Kopstein of Huntington takes photos to classrooms and community groups to talk about her experiences. Claudia Hart, who became a teacher in Connecticut, has devoted a corner of her home to Zaire, which her students visit. David Olson, another Togo volunteer, advocates on behalf of global health issues in Washington.

As Sargent Shriver departs for his next assignment, it's worth noting how many lives he touched by seeing the Peace Corps off to a sound beginning: generations of volunteers, their co-workers and friends around the world, and the people at home who are curious to hear our stories.

He made our world larger, just when the globe was shrinking.

Originally published in Newsday