Just last week, Bernie Sanders rolled out his Medicare for All bill. Sanders and the bill’s advocates railed against the current healthcare system as ineffectual, forgetting (or hoping the public has forgotten) that it’s the product of Democrat ideas and votes.

In Sanders’ fantasy world, single-payer system is the only cure for what ails the American healthcare system. Most of his Democratic Senate colleagues agree. They were wrong about Obamacare and what it would fix and they’re wrong single-payer.

The reality of single-payer’s implementation is incongruent with what it promises to deliver.

Look no further than Britain, who employs a single-payer system, to see what lies ahead if the U.S. chooses to wander down a similar path. There, rationed care is not fear mongering; it’s an unfortunate challenge for the system’s consumers.

Most recently, British government run hospitals have banned hip and knee surgery for smokers and the obese citing budget cuts.

Avik Roy writes at Forbes:

If you’ve been concerned about the fate of veterans’ health care in the U.S., look to its cousin across the pond. A subsidiary of the government-run British National Health Service has decided to bar obese patients and smokers from undgergoing hip and knee operations. “I think we are going to see more and more decisions like this,” said Chris Hopson, the head of NHS Providers told The Telegraph. “It’s the only way providers are going to be able to balance their books.”

The British NHS and the U.S. VA are cousins

The British National Health Service and the U.S. Veterans Health Administration are two of the last remaining socialized health care systems in the world. That is to say, both systems have not only single-payer, government-run health insurance—the government also owns the hospitals and employs the doctors.

When government has that dominant of a role, it has no choice but to prioritize how to spend the money. In May, NHS England disclosed that its health care providers—hospitals, clinics, doctors and the like—had spent £2.45 billion ($3.26 billion) more than they had been allocated.

In North Yorkshire, England, hospital leaders have decided to cut back by denying hip and knee surgeries to smokers who refuse to quit, and those with Body Mass Indices above 30. (If you’re 5’10”, a BMI of 30 is 209 pounds; if you’re 5’5”, it’s 180 pounds.)

“Major surgery poses much higher risks for severely overweight patients who smoke,” said an NHS England spokesman. “So local [providers] are entirely right to ensure these patients first get support to lose weight and try and stop smoking before their hip or knee operation.” The change “saves the NHS and taxpayers millions of pounds.”

No amount of blaming the wealthy or Republicans will alter the math — socialized medicine is simply not sustainable. Roy continues:

Left-wing advocates of the NHS-VA approach argue that rationing isn’t a big deal because in a free-market health care system, health care is “rationed” based on an individual’s ability to pay for it. But that’s balderdash.

In the rest of the economy, when a product or service is too expensive, businesses have the incentive to figure out how to deliver it less expensively. Think how much high-definition TVs cost when they first came out—tens of thousands of dollars—compared to today, when Amazon sells dozens of models for under $100. That economic incentive—to deliver better services with higher quality and lower costs—only exists in the private sector.

The more we can put patients back in control of their own health care dollars, the better. Let’s start with the VA.

Follow Kemberlee on Twitter @kemberleekaye