I think I understand the rationale for cuts to Medicare spending as part of the overall health care reform package, but I have to admit I don’t understand the rationale behind this:

Home care shows, in microcosm, a conundrum at the heart of the health care debate. Lawmakers have decided that most of the money to cover the uninsured should come from the health care system itself. This raises the question: Can health care providers reduce costs without slashing services?

Under the legislation, home care would absorb a disproportionate share of the cuts. It currently accounts for 3.7 percent of the Medicare budget, but would absorb 10.2 percent of the savings squeezed from Medicare by the House bill and 9.4 percent of savings in the Senate bill, the Congressional Budget Office says.

The House bill would slice $55 billion over 10 years from projected Medicare spending on home health services, while the Senate bill would take $43 billion.

Democratic leaders in the House and Senate justify the proposed cuts in nearly identical terms. “These payment reductions will not adversely affect access to care,” but will bring payments in line with costs, the House Ways and Means Committee said. The Senate Finance Committee said the changes would encourage home care workers to be more productive.

The proposed cuts appear to be at odds with other provisions of the giant health care bills. A major goal of those bills is to reduce the readmission of Medicare patients to hospitals. Medicare patients say that is exactly what home care does.

“It helps me be independent,” said Mildred A. Carkin, 77, of Patten, Me., as a visiting nurse changed the dressing on a gaping wound in her right leg, a complication of knee replacement surgery. “It’s cheaper to care for us at home than to stick us in a nursing home or even a hospital.”

Delmer A. Wilcox, 89, of Caribou, lives alone, is losing his vision, uses a walker and has chronic diseases of the lungs, heart and kidneys. He said his condition would deteriorate quickly without the regular visits he received from Visiting Nurses of Aroostook, a unit of Eastern Maine Home Care.

I have always heard that the rationale for emphasizing home health care was twofold, to grant patients more independence and more time at home, and to cut the excessive costs of hospitalization or hospice care. Is that wrong? If not, then why are the cuts focused disproportionately on services that lower the cost of health care overall? Someone smarter than me will have to explain this, because frankly I don’t get it.