There are several good reasons for taxpayers to be wary of Proposition 414 on the Nov. 4 ballot. Even a bit put off.
Essentially, Proposition 414 would create a countywide taxing district to do for the Maricopa Integrated Health System what neither the county nor the state would do: namely, manage and fund it properly.
But there is also good reason to swallow our resentment and frustration and vote for the measure. By severing the county hospital and network of health clinics from county government, Proposition 414 would nudge the system toward privatization, efficiency and possible eventual self-sufficiency.
That's all admittedly iffy. But voting down Proposition 414 also would have consequences.
The consequences probably aren't as draconian as portrayed in pro-Proposition 414 propaganda. The Maricopa Medical Center and its Arizona Burn Center are not likely to be summarily closed. Most members of the Board of Supervisors are on record as opposing such a drastic measure.
But the hospital is a drain on the county, and the supervisors would certainly take steps to stop the fiscal hemorrhaging. Several years ago they tried to sell the hospital, but the deal fell through when the prospective purchaser failed to line up the necessary financing.
The hospital wouldn't be such a burden if the Arizona Legislature would pass along federal funding intended to help hospitals burdened with high numbers of uninsured patients. But the state has budget problems of its own, so that lifeline can't be counted on.
So taxpayers have every right to be miffed at the state, for not providing the necessary funding, and at the county, for not better managing the county hospital. But that doesn't solve the problem. Neither does simply letting the system shut down, which would put a huge physical and fiscal strain on the rest of the Valley's health care system.
What would help is separating the hospital and clinics from county government, which is a massive bureaucracy. Being an appendage of such a large governmental entity subjects the hospital to an unwieldy chain of command and a cumbersome procurement system. Health care priorities are easily lost amid county government's myriad other demands, such as law enforcement and transportation.
Setting up a separate governmental entity, with elected officers, to oversee the health care system would help ensure it gets the attention it deserves. The elected board, like other hospital district boards around the state, would also have the flexibility to either create a private, non-profit hospital operating entity or contract with an existing one to oversee the day-to-day running of the health-care system.
Although few welcome a tax increase, Maricopa Medical Center badly needs upgrading, and that costs money. Yet with a smaller bureaucracy more directly accountable to voters, the health care system could be expected to operate more efficiently and thus limit and even eventually eliminate any tax liability.
Although Proposition 414 is not as glowing as its chief proponents have portrayed it, it does represent a significant step toward better management and fiscal accountability. Proposition 414 won't magically resolve all the problems plaguing the county's health care system, but it provides a practical means of doing so — primarily by at least partially privatizing the system.
If Proposition 414 is approved next month, it will be critically important for voters to elect a top-notch district board to deliver on the promises of this campaign.