For the Republican Party, the only thing worse than lower income Americans not having access to health insurance is having it. That's the conclusion of Texas GOP Senator John Cornyn, who on Sunday deemed the popular Medicaid program that serves 60 million Americans a "health care gulag." That fear-mongering came just days after his Tennessee colleague Lamar Alexander repeatedly branded Medicaid a "medical ghetto."
The Democratic health care reform bills passed by the House and under consideration in the Senate are forecast to trim the federal budget deficit while providing coverage for 36 million and 31 million more Americans respectively. Those figures include 15 million currently uninsured who would become eligible thanks to the expansion of Medicaid.
And it's that prospect that Senator Cornyn on Sunday likened to the life under the Soviet secret police:

"It will limit people's choices to, in many cases, to a government-run program like Medicaid which is essentially a health care gulag, because people will not have any choices but to take that poorly performing government plan."

But if Cornyn's dystopian image on Medicaid wasn't sufficiently dark, Lamar Alexander was warning of something darker still.

As Alexander seemed to suggest on the Senate floor last month, that something darker might be the complexion of Medicaid program beneficiaries:

"We've heard eloquent statements about how moving 15 million low-income Americans into a program called Medicaid, which is a medical ghetto, is not health care reform."
"...Or arrogant in its dumping of 15 million low-income Americans into a medical ghetto called Medicaid that none of us, or any of our families, would ever want to be a part of for our health care."

(While the term "ghetto" is not necessarily laden with racial overtones, it has long been used by Republicans as a dog whistle for precisely that purpose. Just this October, for example, Georgia Republican gubernatorial candidate Rep. Nathan Deal defended his proposed proof-of-citizenship law, "We got all the complaints of the ghetto grandmothers who didn't have birth certificates and all that.")
Of course, as ThinkProgress documented, Medicaid is extremely popular, in part no doubt because it alone provides health care coverage to many people who are often rejected by private plans:

While Alexander may think he is too good for Medicaid coverage, a 2005 Kaiser Family Foundation poll found that 74 percent of Americans consider Medicaid very important and most would oppose cuts to the program. Families USA has pointed out that, despite its flaws, Medicaid is cost-effective and provides a solid foundation on which to expand coverage:
Medicaid is cost-effective compared to private health insurance. After controlling for health status (since Medicaid enrollees tend to have greater health care needs), it costs more than 20 percent less to cover low-income people in Medicaid than it does to cover them in private health insurance.

As for the Republican alternative, Rep. Virginia Foxx (R-NC) in November suggested that it's better to be uninsured than enrolled in the government's Medicaid program:

"I want to ask you if you know that Medicaid patients visit the emergency room at twice the rate of uninsured patients in this country. More government paid insurance is going to increase the number of people going to the emergency rooms."

And as they've made clear for years, the Republicans' solution to the crisis of the American health care system is the emergency room.
It was President George W. Bush who first stumbled upon the answer with his July 2007 eureka moment:

"I mean, people have access to health care in America. After all, you just go to an emergency room."

His findings were confirmed that November by the disgraced former House Majority Leader Tom Delay, who announced, "There are 47 million people who don't have health insurance, but no American is denied health care in America." In July 2009, Kentucky Senator and Minority Leader Mitch McConnell followed suit, "Well, they don't go without health care." Rep. Paul Broun (R-GA) was a last minute addition to the honor roll with his statement last week that "people who have depression, who have chronic diseases in this country...can always get care in this country by going to the emergency room."
If all else fails, Senator Judd Gregg (R-NH) happily proclaimed this week, poor Americans desperate for health care coverage they can't afford can always get a job - a government job. Asked by MSNBC's Dr. Nancy Snyderman what he would say to "to the average American who has played by all the rules who can't have the same health care you have," Gregg laughed:

"If you work for the government, you'll get the same health care I have."

As the expression goes, it's good work if you can get it. And it's got to beat living in a ghetto or a gulag.