In my September column, I argued that the health care agenda of each presidential candidate should be considered as a relevant part of your decision. Now I'm not so sure.

It may be more critical to focus on the economic policy of the next president, as this likely will be the most influential factor in shaping health care during their term.

That may come as a surprise to many of you since, for years, people have considered health care "recession proof." After all, health care is the largest part of our economy, accounting for 16 percent of GNP, one of every 11 jobs and has been growing every year.

Some economists go so far as to point out that our country has been in a recession for some time — except that health care has carried the economy and masked the declines in other areas. Consider this: Since 2001, the health care industry has added 1.7 million jobs. The rest of the private sector? None.

Furthermore, it's often said that people will get sick regardless of what's going on in the economy and they can rely on publicly funded safety net programs if worse comes to worse. Unfortunately, we can't consider health care to be immune from our financial crisis and America's health system will be sorely tested by this economic turmoil.

There already are signs that Americans are cutting back on health care spending and holding back on preventative and elective procedures. Physician office visits have dropped since 2006, and 22 percent of consumers in a recent survey said that economic woes were causing them to go to the doctor less often. One result is that the number of prescriptions filled per year in the United States has declined for the first time in a decade. In addition, there are clear downward trends in knee replacements, pap smears and other fairly common medical events.

It's no secret we are all bearing a larger portion of our health care costs and this is discouraging individuals from seeking care. After years of double-digit increases in premiums, many employers are choosing to increase the amount that employees will pay for out-of-pocket items such as deductibles and co-payments. According to a recent report by Hewitt Associates, out of pocket health care costs are expected to increase by 10.1 percent between this year and next to an average of $1,880 while premium increases are averaging 7.8 percent.

What about state and federal safety nets? These are under strain and some will struggle to survive. Every 1 percent increase in the national employment rate translates to 1 million more enrollees in Medicaid and the State Children's Insurance Program (SCHIP) adding $1.4 billion to state and federal budgets.

The U.S. Census Bureau recently reported that Wisconsin has the third- lowest rate (10.3 percent) of uninsured residents, trailing only Minnesota and Hawaii. Our state budget is not prepared for a large influx of participants. Medicare already is struggling with an aging population that is consuming health care faster than it is funded.

Finally, let's not forget the personal health impact of stress and anxiety caused by rising unemployment, record home foreclosures and market uncertainty. Prolonged stress, emotional and physical, impacts your cardiovascular status, particularly blood pressure. This stress can cause constriction of coronary blood vessels and heightened electrical instability in the heart. Stress hormones, called catecholarmines (including adrenaline), can have damaging effects on heart muscle if exposed to elevated levels for a long time.

Throw in the fact that many people react to stress by eating poorly, stopping exercise, smoking, drinking and missing medications and it's easy to see why a recent study showed that people under 50 who suffered chronic stress have a 68 percent higher risk of heart disease.

So, pick your candidate based on their economic plan. More importantly, don't forego any necessary preventative services, get some exercise and don't stress much over the election — there are plenty of other things to worry about. <br>