There is a particular kind of policy document that reads like an admission. Buried in the small print of America's newly proposed Medicare physician fee schedule is a question CMS has apparently decided it can no longer avoid asking out loud: why does a private lobbying body still own the code that decides how much every American doctor gets paid for every single thing they do. For many years, US clinical behaviour has been subtly influenced by the Current Procedural Terminology system, which is licensed by the American Medical Association and reputedly generates hundreds of millions of dollars in royalties annually. Doctors are paid more for doing procedures than for preventing the need for them. The incentive is baked into the plumbing of the system, not layered on top of it.

CMS has now opened a formal request for information asking whether that arrangement should survive, alongside proposals to sunset the traditional Merit-based Incentive Payment System by 2029, lower the barrier to entry for Accountable Care Organisations, and let high-performing networks waive out-of-pocket costs for low-income beneficiaries. Family physician groups have welcomed the direction while objecting, with some justification, to a roughly 1.2 per cent cut to the underlying conversion factor once a temporary legislative uplift expires. It is the familiar pattern of American health reform: bold structural ambition arriving in the same document as a real-terms pay reduction, with Congress left to referee the contradiction.

None of this maps cleanly onto the NHS. Britain does not have a CPT problem, because it does not have a private monopoly sitting between clinical activity and clinical payment. NHS coding runs through Healthcare Resource Groups and SNOMED CT, both held in public hands rather than licensed from a trade body with a commercial interest in complexity. There is no equivalent scandal waiting to be uncovered in the ownership of English clinical terminology. Anyone tempted to import this story wholesale into a UK health policy argument should resist the urge.

But the underlying question CMS is grappling with, whether a payment system quietly rewards volume over value, is one this country has answered badly before and has not yet convincingly answered now. For whatever reason, Payment by Results spent years pressuring trusts to engage in activities that produced tariff revenue as opposed to those that preserved public health. Workforce distribution in England has its own version of America's specialty drift, with training bottlenecks and pay differentials still pulling doctors away from general practice at exactly the moment ministers say they want more of it delivered in neighbourhoods rather than hospitals. Wes Streeting's Ten Year Health Plan is largely focused on community-based care and prevention, which is virtually exactly what CMS claims it wants from primary care reform in the United States. The difference is that Washington is at least willing to interrogate the financial architecture underneath the rhetoric, asking who benefits from the current coding structure and who would be disadvantaged by changing it.

That willingness matters more than the specific mechanism. England's equivalent conversations, about GP contract reform, about ARRS funding rules, about how Integrated Care Boards actually allocate money between acute and community providers, tend to stay procedural rather than structural. Nobody in Whitehall is asking whether the incentive architecture itself is the obstacle, in the way CMS is now prepared to ask about CPT. The American proposal may fail, watered down by lobbying or abandoned by a future administration. But the instinct behind it, that prevention cannot be willed into existence while payment systems still reward its opposite, deserves a more honest hearing in this country than it has so far received. Streeting's plan will be judged not on its stated ambitions but on whether the money underneath it is finally made to agree with them.