The roll out of Healthcare.gov has given plenty of ammunition to opponents of health care reform, who style themselves as crusaders against incompetence. While many who oppose the program do so in good faith, some critics carry an ugly prejudice against sick and disabled people.

That prejudice is “just deserts” — the idea that people get what they deserve. Rich people deserve their luxury. Poor people deserve their poverty. Sick and disabled people deserve their misery. You have heard this before, even if you did not know its name.

When we say we believe someone deserves a good or service — education, protection from crime, a secure retirement — we are obliged to find some means to provide it. Usually this is through government, although for retirement we rely on a mix of private and public programs. When someone says sick people do not deserve health care, they are saying that sick people deserve to be sick — “just deserts.”

This idea comes mostly from the Judeo-Christian “doctrine of retribution”: the belief that evil is punished and good is rewarded. In the Christian Bible, Jesus can heal the sick because he can forgive sin. This made sense when people were ignorant about the causes of illness — when demon-possession was a valid differential.

Today we know that microbes and genetics and environmental causes are what make people sick. The same bug that kills poor kills rich; the same antiobiotic that cures rich cures poor. If God is making us sick, we have no way of separating that from all the other reasons people get sick.

Yet even today, there are people who believe that sick and disabled people deserve their circumstances. In the 1980s, a scholar — PhD and everything — argued against special education programs:

They (the handicapped) falsely assume that the lottery of life has penalized them at random. This is not so. Nothing comes to an individual that he has not, at some point in his development, summoned. Each of us is responsible for his life situation.

Her name was Eileen Gardner: she was later appointed to the Department of Education, only to be ousted once her bigotry became public knowledge.

Would that were the end of it, but you do not have to look far to see evidence of similar prejudice. In 2010 a Virginia lawmaker argued that disabled children are punishment for women who abort their first-born.

Sick people sometimes internalize this message, too. Melissa Etheridgeʼs comments on Angelina Jolie — that “cancer comes from inside you and so much of it has to do with the environment of your body” — implied she deserved her own cancer for having too much “acidity” in her personality.

Not everyone who holds this view espouses it freely; most lawmakers recognize that “just deserts” is an unpopular idea. But even if they cannot say so outright, many lawmakers — including several Republican governors — have declared, more or less, that they do not believe their sick and disabled deserve adequate health care.

The question opponents of reform should answer is this: do you believe sick and disabled people deserve care? We should welcome any critique of healthcare reform which begins with a “yes” answer — even if we disagree with the critic.

What we should not tolerate is any attempt to smuggle medieval dogma into the debate. We should recognize the prejudice that sick people deserve their illness for what it is: archaic, ignorant, and cruel.

Duncan Cross blogs from the perspective of a chronic patient at his self-titled site, Duncan Cross.