In the McCombs School of Business where I teach, we often talk to our students about the impact of "the weakest link" on processes, productivity, and plans. We teach that a good manager focuses on improving the strength and performance of the weakest link to improve overall throughput and productivity. The Affordable Care Act was the first major legislation since Medicare/Medicaid in 1965 to improve access and affordability of health care for some of America’s weakest links – the 40 million souls who had no insurance back in 2007.

Before the ACA, affordable health care eluded many and drove others to suboptimal decisions. People stayed in jobs that did not fully use their talents in order to keep health insurance, denying America the opportunity of reaping the rewards of their entrepreneurial ideas. Families headed by hard-working parents delayed or neglected basic health care needs due to lack of coverage from their employers, robbing America of years of productive labor when cancer or diabetes cut their lives unnecessarily short.

In states like Texas, if you have a job, even a part-time one, you make too much money to qualify for Medicaid, so if your employer does not offer coverage and affordable coverage is not available to you on your own, you go without and become a weak link for your family, your community and your country. In fact, medical expenses remain the single largest cause of personal bankruptcy in America.

These issues drove the development of the ACA’s "three-legged stool":

• Rules that require insurers to provide a standard amount of coverage for all without threat of cancellation or denial (ensuring access to insurance)

• Requirements that everyone buy insurance and all employers (100+) offer insurance (ensuring a broad distribution of health risks in the market, fair pricing, insurance solvency/health care industry solvency)

• Subsidies to make that insurance affordable (ensuring access for insured)

These three concepts are at the heart of the legislation. Eliminating one of these legs leads us back to where we were in 2007 because access will either be limited by insurance companies trying to remain solvent or will be priced too high for the people who need it. Leaving the management of health care to the free market will ensure that America’s weak link will worsen, not improve. In an unregulated market, health care will be rationed based on ability to pay as opposed to medical need. Unlike travel or hospitality, health care is a service that does not have the characteristics necessary to be successfully managed by markets. These characteristics include:

• Imperfect information – the average consumer does not know enough about health care to make a reasoned choice.

• Health is priceless – there is no diminishing utility in health care; we will always want more.

• Cost-benefit decisions are emotional, not rational – it makes sense to stop spending resources on a patient who is dying … until it’s your mother.

• Lifestyle matters more than medicine – the market focuses on the technology it can sell, but what matters most to health are the much cheaper (therefore less attractive to the market) prevention services and lifestyle choices.

It is an expensive proposition to improve access to health care in America, and we need to begin paying that cost instead of denying the need for it. We cannot put our heads in the sand and turn the clock back to replicate the 2007-era situation without making our problems in the future even bigger, burdening our country with productivity loss and our working-class families with hardship, diminished options, and the impossible choice between medical care and poverty.