As Democrats ramp up their push to bring a single-payer health care system to the United States, the United Kingdom made a dramatic move to curb the growing cost of their program – denying routine surgeries to the obese and smokers unless they change their ways.

Often held up by Democrats as a model for a single-payer system in the US, the UK’s National Health Service controls costs by rationing access to care. In their latest bid to limit costs, the UK Telegraph reports the Vale of York Clinical Commissioning Group decided “patients with a body mass index (BMI) of 30 or above – as well as smokers – will be barred from most surgery for up to a year amid increasingly desperate measures to plug a funding black hole. The restrictions will apply to standard hip and knee operations.”

Each region of the UK manages their own costs, but the decision is expected to have wide-ranging repercussions as other areas scramble to deal with ever-increasing costs.

Vermont Senator and runner-up for the Democratic Party’s 2016 presidential nomination Bernie Sanders announced this week he is working on finalizing his proposal for a single-payer health system in the US. A proposal for a single-payer plan was offered during the Obamacare repeal debate last week in the Senate and was defeated 57-0, with most Democrats voting “present” rather than go on record one way or the other on the concept.

The Royal College of Surgeons in the UK called the rationing move by the NHS the “most severe the modern NHS has ever seen.”

The Telegraph reports, “Smokers who refuse to quit will have planned operations postponed for six months, but may be included on surgeons’ waiting lists earlier by proving they have given up for at least eight weeks.”

As for the obese, the paper reports people “who have a BMI of 30 or more will be barred from routine surgery for non-life-threatening conditions for a year, although they may secure a referral sooner if they shed 10 per cent of their weight.”