THE REPUBLICAN E.R. PLAN…. John McCain’s healthcare plan, by his campaign’s own admission, doesn’t even try to extend coverage to every American without insurance. We’re starting to get a better sense as to why this is.

[John Goodman, president of the National Center for Policy Analysis, a right-leaning Dallas-based think tank] who helped craft Sen. John McCain’s health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care.)

“So I have a solution. And it will cost not one thin dime,” Mr. Goodman said. “The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American — even illegal aliens — as uninsured. Instead, the bureau should categorize people according to the likely source of payment should they need care.

“So, there you have it. Voila! Problem solved.”

This nonsense is surprisingly common in Republican circles. Last year, Tom DeLay argued, “[N]o American is denied health care in America,” because everyone can go to the emergency room. Around the same time, George W. Bush said the same thing: “[P]eople have access to health care in America. After all, you just go to an emergency room.” In 2004, then-HHS Secretary Tommy Thompson said our healthcare system “could be defined as universal coverage,” because of emergency rooms.

In a way, they’re right. If you’re sick, there are public hospitals that will treat you.

But as is too often the case, conservatives haven’t thought through the implications of their argument. First, it’s extremely expensive to treat patients this way, and it would be far cheaper, and more effective, to pay for preventative care so that people don’t have to wait for a medical emergency to seek treatment.

Second, under this McCain/Bush/DeLay model, sick people with no insurance go to the E.R. for care. They can’t pay the bills, and hospitals can’t treat sick patients for free, so the costs are passed on to everyone else.

In other words, the man responsible for crafting McCain’s healthcare policy effectively described the most inefficient system of socialized medicine ever devised.

Update: Of course, if we take McCain’s policy advisor at his word, and build a “socialized medicine” system around public hospitals, there’s a perfectly good model to follow: it’s called the VA system.

Steve Benen

Follow Steve on Twitter @stevebenen. Steve Benen is a producer at MSNBC's The Rachel Maddow Show. He was the principal contributor to the Washington Monthly's Political Animal blog from August 2008 until January 2012.