Ideology and trust: a reply to Bloche.

On first reading, I was taken aback, almost stunned, by Gregg Bloche's response to my article. It opens with a story about betrayal of trust by the physician for his dying mother and it closes with the heart-stopping accusation that I am attempting to "remak[e] health law as a tool for limit-setting by deceit,... [which] would lead to downward cycles of anger and distrust, with tragic consequences for medicine's healing potential."l I wondered, what had I done to prompt this depth of outrage and outpouring of accusation and analysis? Had I forgotten what my own article was about? I immediately reread my article to make sure my memory was not playing tricks on me. Then I reread Bloche's response, several times, and thought long and hard about what is really on his mind. Here is what I've concluded.