It has come to this: We need to kneecap Medicare to pay for tax cuts.

That’s the real story behind the latest push in Congress, where Senate Republicans are eyeing more than $200 billion in Medicare reductions — not to control spending, but to help pay for what some are calling the “Big Beautiful Bill,” a sweeping package larded with tax breaks.

Long-term care operators know all too well that budget politics can get messy and dangerous. But this time, it’s not just messy — it’s menacing. These proposed Medicare cuts come on the heels of more than $800 billion in Medicaid reductions already approved by the House. For those of you keeping score at home, that adds up to a $1 trillion haircut.

To justify it all, lawmakers are leaning on the old reliable: the need to eliminate “waste, fraud and abuse.” It’s a comforting phrase, a political lullaby that’s been used for decades to make harsh policy moves sound like responsible stewardship.

But anyone in this field knows the real score. Cuts under the guise of “efficiency” rarely feel like smart reform on the ground. More often, they mean missed payments, thinned-out staff and compromised caregiving.

So far, advocates are playing it cool, saying this $200 billion “modernization” push won’t really harm beneficiaries. The idea, we’re told, is to streamline Centers for Medicare & Medicaid Services operations and target bad actors. It’s possible that will happen too. But if your BS detector isn’t going off, it’s time for a battery change.

Because when policymakers start looking for “savings” in Medicare and Medicaid, it’s long-term care providers — and their residents — who bear the brunt. The budget cuts may be dressed up in fiscal responsibility, but their purpose is anything but. This isn’t about fixing the system. It’s about freeing up cash for a different agenda entirely.

To be clear: Rooting out inefficiencies is not inherently wrong. But this looks less like reform and more like robbing Peter to pay for Paul’s tax cut.

 John O’Connor is editorial director for McKnight’s.

Opinions expressed in McKnight’s Long-Term Care News columns are not necessarily those of McKnight’s.