There's been just one election for the Maricopa County Special Health Care District Board and people might be hard-pressed to recall who they voted for or what the board has been doing in the meantime.
But the campaign to run the county's public health system is earning a higher profile this year thanks to inter-party squabbling, some significant fundraising, and an aging, overburdened hospital.
Five board members administer a system that primarily serves the Valley's poor and uninsured with a $414 million budget that includes nearly $50 million in business and residential property taxes.
The centerpiece is the 450-bed Maricopa Medical Center in Phoenix, along with 11 clinics, two psychiatric centers, a nationally known burn unit and a health insurance plan.
Voters approved the health care district in a special election in 2003, created a property tax hike to help fund it and a nonpartisan board to run it. The current board was elected the following year.
No matter what happens Nov.4, the board will look dramatically different. Only two members are running for re-election, including William "Bil" Bruno, of Chandler, in District 1. The five health districts mirror the supervisory districts.
"I believe in this," Bruno said. "It's an essential part of our health care network here in the Valley."
Though the job is unpaid and, ostensibly, nonpartisan, 14 Republicans are running and a slate of five conservatives have been endorsed by GOP insiders.
That's raised the ire of the incumbents and more moderate candidates, some of whom fear the real motive is to squeeze the district until the hospital is forced to close.
And it's led to the kind of heated rhetoric that more often characterizes campaigns farther up the ballot. But the candidates say the stakes in this race - such as health care and taxes and public safety - couldn't be higher.
Newcomer Rex Altree, of Gilbert, who is challenging Bruno and got the endorsement of the conservative Pachyderm Coalition, said the 40-year-old hospital needs to stay open. But he opposes construction of a new facility, which the current board has championed.
"I think it serves a wonderful purpose. But I think we need to tighten up on things," Altree said. "I'm a good businessman. That's what the hospital is, ultimately, is a business."
Voters in the north East Valley's District 2 will choose between a doctor, a lawyer and an accountant.
Dr. Harlan Stratton, of Scottsdale, moved here three years after retiring from his orthopedic surgery practice in Indiana. He was quick to jump on opponent Rob Carey for being an attorney and spending his own money to get elected.
"I think it's an important job. I'm also not trying to buy my way into it," Stratton said. "I want to be an advocate for patient care and a steward of the taxpayers' money. And I think I can do both."
Carey, former special assistant attorney general under Grant Woods, said he's the most qualified candidate and would give the health care district the attention it deserves. And he makes no excuses for spending money to get his message out.
His work includes health care-related litigation, including a case to force the reopening of Charity Hospital in New Orleans, which was inundated by Hurricane Katrina. Maricopa Medical Center, Carey said, has been similarly neglected.
"Some people have a very different view of what public health care should be and how much resources should be put into it," said Carey, of Paradise Valley. "The one thing the board needs is some people with some experience and some common sense."
Blogger and former state Rep. Greg Patterson, of Scottsdale, believes he's as conservative as the next guy, but is concerned about the slate, which includes Stratton, endorsed by the GOP coalition.
"Even for conservatives, there is an acknowledgment that there is a role for government in taking care of people who have no capacity to take care of themselves in a crisis," he said. "So the question is, how do you do it most efficiently? And there's a government role in that."
Two former state lawmakers are vying for the District 3 board seat: Susan Gerard, who recently stepped down as director of the state Department of Health Services, and Colette Rosati, a nurse and Pachyderm-endorsed conservative.
Rosati, of Scottsdale, is concerned that the board is wasting money on lobbyists and consultants, while spending too much time in executive session.
Although she doesn't believe the hospital should be shuttered, Rosati said there are plenty of ways to cut costs and has vowed not to raise property taxes.
"They get tons of money. What do they with all the money that they get," she said. "This is why people who are clued in ... they know it's just runaway spending."
Like her more moderate colleagues, Gerard said the Valley's health depends on the health of the safety-net hospital, which also serves as a teaching facility for thousands of doctors and nurses each year.
"You have to have some expertise. I've got the necessary credentials to understand what it's actually like to run a hospital," said Gerard, of Phoenix.
"And I don't really think my opponent has anywhere near the qualifications that I have, nor the commitment to making sure the hospital is successful."