Is marriage becoming extinct?

As poverty grows and the gap between rich and poor widens, there's a narrative developing that women may have taken this equality stuff too far.

Today, 41 percent of births in the United States occur outside of marriage, compared with 17 percent in the 1980s. The decline in marriage leaves parents - mostly mothers - to struggle alone financially. Depending on which study you read, sociologists believe that single parenting accounts for 15 to 40 percent of a family's likelihood of living in poverty.

Even Isabel Sawhill, who directs the Center on Children and Families for the moderately liberal Brookings Institution, wrote in May that former Vice President Dan Quayle was right 20 years ago about Murphy Brown: Unmarried motherhood is a bad choice. Children who grow up poor more often act up in class, become teenage parents and drop out of high school.

But this narrative implies that the rise of women's rights is to blame for all these changes - or that it is reversible. The bad news story also ignores the gains arising from the greater earning power of women, the looser divorce laws and the reduced social censure that have enabled so much single parenthood. The rate of domestic abuse has dropped steadily, for example, and women are less likely to commit suicide or be killed by an intimate partner.

Many single parents are raising wonderful children - I know several - but they don't have an easy job. We need to acknowledge that we are headed for a post-marital world, and adopt policies that will give the children of such families a better chance at a secure middle-class adulthood. Such policies will lighten the single parent's load, too, although that's no reason to oppose them.

First, we could educate teenage fathers about their responsibilities to their children. There's a lot of advice out there for girls but very little for guys. A man has the right to know whether he is the father, and to seek to be involved in raising the child. Men have a responsibility to provide financial support, and to see that decisions are being made in the child's best interest.

Counseling for couples planning to marry should be easily available. So many of us marry without a realistic view of how to live together. A handful of states - Florida, Maryland, Minnesota, Oklahoma, Tennessee - have passed legislation providing financial incentives for couples to participate in formal premarital education.

We must find other ways for kids to have more parental figures - if they can't have both biological parents - in their lives. For example, some builders have begun designing homes to accommodate multiple generations. Family rooms and dining rooms are larger, and the homes include two master bedrooms at opposite ends of the house, for privacy. Overall, the American housing market is trending toward smaller - but this home-sharing concept is part of the mix.

Living near extended family, having community centers and places of worship that attract all generations, extending the school day to accommodate extracurricular activities and homework help - these are also crucial.

If I hadn't met my husband and formed a traditional family, I may have had a child on my own. I was considering it in 1992, when the veep made his quip about Murphy Brown. Life's drive to recreate itself is very strong. That's something people don't mention often enough in these discussions.

If American marital norms are morphing into something we wouldn't have recognized 20 years ago, well, so be it. Let's take what good marriages have taught us about children's need for belonging and the influence of caring adults, and make sure we meet that need - no matter what forms our families take.

This essay was first published in Newsday.

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