Social Security payments shrink in 2010-2011

For many retirees, Social Security provides the only stable and predictable income in this uncertain economy where shrinking investments, rising food and fuel costs and skyrocketing healthcare expenses make living on a fixed income increasingly difficult. While Social Security remains the bedrock of retirement security, the average Social Security retirement benefit is modest. The trustees who oversee Social Security are projecting there won't be a cost of living adjustment (COLA) for the next two years. Next year, is the first time in a generation that payments would not rise. That hasn't happened since automatic increases were adopted in 1975.

By law, Social Security benefits cannot go down. Nevertheless, monthly payments would drop for millions of people in the Medicare prescription drug program because the premiums, which often are deducted from Social Security payments, are scheduled to go up slightly. More than 32 million people are in the Medicare prescription drug program. Average monthly premiums are set to go from $28 this year to $30 next year, though they vary by plan. About 6 million people in the program have premiums deducted from their monthly Social Security payments, according to the Social Security Administration.

Millions of people with Medicare Part B coverage for doctors' visits also have their premiums deducted from Social Security payments. Part B premiums are expected to rise as well. But under the law, the increase cannot be larger than the increase in Social Security benefits for most recipients. It is predicted Medicare premiums and out-of-pocket expenses will consume nearly $3 of every $10 of the average Social Security benefit.

President Barack Obama has said he would like tackle Social Security next year, after Congress finishes work on health care, climate change and new financial regulations. Social Security is facing long-term financial problems. The retirement program is projected to start paying out more money than it receives in 2016. Without changes, the retirement fund will be depleted in 2037, according to the Social Security trustees' annual report this year.

Lawmakers are preoccupied by health care, making it difficult to address other tough issues. Advocates for older people hope their efforts will get a boost in October, when the Social Security Administration officially announces that there will not be an increase in benefits next year.

Prescription Pain Medication Addiction

Prescription pain medicine addiction grabs headlines when it sends celebrities spinning out of control. It also plagues many people out of the spotlight who grapple with painkiller addiction behind closed doors. But although widespread, addiction to prescription painkillers is also widely misunderstood -- and those misunderstandings can be dangerous and frightening for patients dealing with pain. Where is the line between appropriate use and addiction to prescription pain medicines? And how can patients stay on the right side of that line, without suffering needlessly?

Here are seven myths they identified about addiction to prescription pain medication.

1. Myth: If I need higher doses or have withdrawal symptoms when I quit, I'm addicted.
Reality: That might sound like addiction to you, but it's not how doctors and addiction specialists define addiction. "Everybody can become tolerant and dependent to a medication, and that does not mean that they are addicted," says Christopher Gharibo, MD, director of pain medicine at the NYU Langone Medical School and NYU Hospital for Joint Diseases. Tolerance and dependence don't just happen with prescription pain drugs, notes Scott Fishman, MD, professor of anesthesiology and chief of the division of pain medicine at the University of California, Davis School of Medicine. "They occur in drugs that aren't addictive at all, and they occur in drugs that are addictive. So it's independent of addiction," says Fishman, who is the president and chairman of the American Pain Foundation and a past president of the American Academy of Pain Medication. Many people mistakenly use the term "addiction" to refer to physical dependence. That includes doctors. "Probably not a week goes by that I don't hear from a doctor who wants me to see their patient because they think they're addicted, but really they're just physically dependent," Fishman says. Fishman defines addiction as a "chronic disease ... that's typically defined by causing the compulsive use of a drug that produces harm or dysfunction, and the continued use despite that dysfunction."

2. Myth: Everyone gets addicted to pain drugs if they take them long enough.
Reality: "The vast majority of people, when prescribed these medications, use them correctly without developing addiction," says Marvin Seppala, MD, chief medical officer at the Hazelden Foundation, an addiction treatment center in Center City, Minn. "I think where it gets really complicated is when you've got somebody that's in chronic pain and they wind up needing higher and higher doses, and you don't know if this is a sign that they're developing problems of addiction because something is really happening in their brain that's ... getting them more compulsively involved in taking the drug, or if their pain is getting worse because their disease is getting worse, or because they're developing tolerance to the painkiller," says Susan Weiss, PhD, chief of the science policy branch at the National Institute on Drug Abuse.

3. Myth: Because most people don't get addicted to painkillers, I can use them as I please.
Reality: You need to use prescription painkillers (and any other drug) properly. It's not something patients should tinker with themselves. Gharibo says that he doesn't encourage using opioids alone, but as part of a plan that also includes other treatment -- including other types of drugs, as well as physical therapy and psychotherapy, when needed.

4. Myth: It's better to bear the pain than to risk addiction.
Reality: Undertreating pain can cause needless suffering. If you have pain, talk to your doctor about it, and if you're afraid about addiction, talk with them about that, too. Fishman remembers a man who came to his emergency room with pain from prostate cancer that had spread throughout his body. "He was on no pain medicine at all," Fishman recalls. Fishman wrote the man a prescription for morphine, and the next day, the man was out golfing. "But a week later, he was back in the emergency room with pain out of control," says Fishman. "He stopped taking his morphine because he thought anyone who took morphine for more than a week was an addict. And he was afraid that he was going to start robbing liquor stores and stealing lottery tickets. So these are very pervasive beliefs."

5. Myth: All that matters is easing my pain.
Reality: Pain relief is key, but it's not the only goal. "We're focusing on functional restoration when we prescribe analgesics or any intervention to control the patient's pain," says Gharibo. He explains that functional restoration means "being autonomous, being able to attend to their activities of daily living, as well as forming friendships and an appropriate social environment." In other words, pain relief isn't enough.

6. Myth: I'm a strong person. I won't get addicted.
Reality: Addiction isn't about willpower, and it's not a moral failure. It's a chronic disease, and some people are genetically more vulnerable than others, notes Fishman. "The main risk factor for addiction is genetic predisposition," Seppala agrees. "Do you have a family history of alcohol or addiction? Or do you have a history yourself and now you're in recovery from that? That genetic history would potentially place you at higher risk of addiction for any substance, and in particular, you should be careful using the opioids for any length of time." Don't share prescription pain pills and don't leave them somewhere that people could help themselves. "These are not something that you should hand out to your friends or relatives or leave around so that people can take a few from you without your even noticing it," says Weiss.

7. Myth: My doctor will steer me clear of addiction.
Reality: Doctors certainly don't want their patients to get addicted. But they may not have much training in addiction, or in pain management. Most doctors don't get much training in either topic, says Seppala. "We've got a naïve physician population providing pain care and not knowing much about addiction. That's a bad combination." Fishman agrees and urges patients to educate themselves about their prescriptions and to work with their doctors. "The best relationships are the ones where you're partnering with your clinicians and exchanging ideas."

Misinformation About Hospice\Palliative Medicine in Health Care Reform Bill

Help Correct Misinformation About Hospice and Palliative Medicine in Health Care Reform Bill

The American Pain Foundation and the American Academy of Hospice & Palliative Medicine (AAHPM) request your help in correcting misinformation about hospice and palliative medicine in the health care reform bill. Your voice is urgently needed to weigh in on the health care reform debate. Provisions AAHPM worked hard to have included in health care reform legislation are now being attacked, and some members of Congress have been hearing from constituents who've been misinformed. We need you to correct the record!

America's Affordable Health Choices Act (H.R. 3200) contains a provision that would provide coverage under Medicare for people to talk to their doctor about their wishes and care preferences at the end of life. This has prompted some groups to falsely claim that care planning consultations include "euthanasia," that physicians would be required to "recommend a method for death" and that such consultations would be "mandatory every five years." These claims are blatantly false.

The provision included in H.R. 3200 simply allows Medicare to pay for a conversation between a patient and their doctor if the patient wishes to speak about their preferences and values. This benefit would be purely voluntary, and patients do not need to have this consultation with their doctor if they do not wish to do so. The new Medicare benefit would allow doctors to be compensated for these conversations every five years, and more frequently if a patient has a life-limiting illness or health status changes.

Staff for U.S. Rep. Earl Blumenauer (D-OR), who sponsored the original legislation on advance directives, have been reaching out to other Congressional offices in an effort to clarify mischaracterizations of the health care reform legislation. Now they are asking to hear from you. They need quotes from patient advocates and health care providers so they can help correct the record and promote the benefits of advance care planning among the members of Congress.

If you wish to weigh in on this legislation, please forward a quote - no more than a few sentences - to Christa Shively in Sen. Blumenauer's office stating why these provisions in the health care reform bill are important. These should be positive statements about improving patient care and helping families through difficult times. They need your feedback as soon as possible. You may also want to follow up with your own representatives in Congress - let them know that you support this and other hospice and palliative care provisions in the health care reform bills.

Please contact AAHPM Advocacy with any questions.

PLEASE NOTE: Members of Congress will recess and return to their home states for an August work period. AAHPM urges you to make an appointment with your representatives for this time, to discuss the benefits of hospice and palliative care provisions now included in the health care reform bills. Your voice is crucial to ensuring all of these provisions remain in the final version of reform legislation.