“In a commercial country, a busy country, time becomes precious, and therefore hospitality is not so much valued. No doubt there is still room for a certain degree of it; and a man has a satisfaction in seeing his friends eating and drinking around him.” — Dr. Samuel Johnson
Ross Betts writes: Doctor Johnson, who lived during only the beginning of the industrial revolution, nevertheless understood what was in store for us as that movement spread to all aspects of life. The diminution of hospitality in all life has now been noted by many authors, from Margaret Visser to Leon Kass to Christine Pohl. Working in a hospital, one is keenly aware of how industrial processes, whether they are imposed through government force or private insurance companies, diminish the possibility of expressing hospitality to the infirm.
The myriad regulations which define the hospital experience diminish hospitality as other goals are advanced. We cannot even use patients’ names in many circumstances for fear of a violation of the Health Insurance Portability and Accountability Act‘s privacy rules. We cannot sing or laugh too loudly among them for fear of lowering our federally mandated Hospital Consumer Assessment of Healthcare Providers and Systems scores, a metric that Medicare uses to advance “quality.” The hospitals are graded on quietness. HCAHPS scores, together with the satisfaction of mathematical goals with respect to certain diagnoses, constitute the Value Based Purchasing program of Medicare, a program designed to limit payment to hospitals. The law encourages anonymity and silence. Quality managers tell us that silence promotes healing—an evidence-based claim with dubious evidentiary support. Silence, through Medicare rules, also generates better reimbursement, and this is what hospital administrators and boards attend to. Hospitality is thus subordinated to other concerns.