The mayor of Shelby County, Tennessee, is one of the relatively few local officials in America who regularly conducts business across state lines. As mayor of the county that includes Memphis and sits just outside Arkansas and Mississippi, A C Wharton Jr. oversees the Memphis Regional Medical Center, which boasts the only Level 1 trauma center to be found for 150 miles in any direction. Arkansas and Mississippi together send more than $20 million worth of business annually to The Med, as the hospital is known locally. The problem is that these states send almost no money to help pay the costs of treating their citizens.

On a recent Friday afternoon, Wharton crossed the Mississippi River to meet with Jamie Carter, who runs Crittenden Memorial Hospital in West Memphis, Arkansas. Carter commiserated with Wharton about The Med's importance, saying that he couldn't handle the load if it were to close. "The golden hour for East Arkansas," Carter says, referring to the time period following a severe injury when a patient's life can be saved, "simply dictates that The Med has to be open." Recognizing its importance, Arkansas recently named The Med an anchor of its new statewide trauma network. But, so far at least, the dollars haven't followed the flattery. During the most recent fiscal year, Arkansas imposed on The Med $12 million worth of costs, and paid just $24,000 in reimbursements.

Wharton successfully lobbied Congress earlier this year to change Medicaid laws, which previously did not allow states to send federal dollars outside their own borders to pay for most of the care provided in other states. But to do so, they'd also have to send along their own matching funds. Given the troubles with state finances these days, there's not much chance of that happening. Officials at The Med hoped the legislation would bring them $7 million worth of new funding, but instead they got a big goose egg. "I don't care how bold a politician you are, it's a hard sell to send money out of state," Wharton concedes.

Still, he has to keep trying. His hospital needs the money--it's shedding staff and services fast, due to the shortage of dedicated government funds. For Wharton, there's a simple question of equity involved when a facility such as The Med, which sits at the corner of three states and provides essential services to all of them, can't get paid properly. "This is not a park or a regional golf course we're talking about," he says. "This simply cries out for a regional solution."

For Wharton, regional solutions are never far out of mind. The county mayor has kicked off a chain of events that will lead next year to a vote on merging the city of Memphis with Shelby County--an idea that has been kicking around locally for decades. It's still a tough sell--suburbanites are not enamored of the idea of taking on the debt and social problems of a central city they fled years ago. But the fact that it's Wharton who's raising the issue may help. For years, the main champion of regionalism in this area has been longtime Memphis Mayor W.W. Herenton. But as his administration became embroiled in a seemingly endless series of corruption investigations, Herenton himself publicly acknowledged that he was too great a "lightning rod" to continue championing the cause of consolidation.

Wharton is ready to step into that role. Herenton resigned in July saying he wanted to run for Congress, and the 65-year-old Wharton is heavily favored to replace him in the October 15 special election. He is convinced he can do more for the cause of consolidation as chief executive of the city than in the much less powerful county mayor's position he has held for seven years.

In the mayoral campaign, Wharton tries to avoid personalizing the issues wrapped up in a merger of the two governments. He told an audience of paper company employees recently that they shouldn't support it "just because of that nice white-haired man who told us about it."

But the fact remains that a primary source of Wharton's popularity is his ability to bridge the many divides that define politics in Memphis--between the abject poor and its Fortune 500 companies, between the city and its suburbs, and between black and white. Ask local political scientists why Wharton is favored to become the next mayor, and they'll readily tell you it's because he's an African American who makes white people feel comfortable. Wharton's efforts at bringing about consensus go deeper than that, however. On any given issue--whether it's disaster preparedness or looking at ways to build on Memphis' economic base as a cargo hub--Wharton's method has been to bring together as many players and competing regional interests as possible. "We would be farther down the road to consolidation today," says Kenneth Robinson, the county health officer, "if the first person who had proposed it was A C Wharton."

John Grisham, who once was a student of Wharton's at the University of Mississippi law school, caricatured him in his 1995 novel The Rainmaker, describing him as a man with a "crooked bow tie" and "wild hair." That was an inside joke. In truth, Wharton is extremely fastidious and sometimes shockingly kempt. When Memphis is at its hottest and stickiest, he usually is the last person to remove his coat. If you give in to the heat by loosening your tie, he says, that's when you'll start to feel it. Wharton's ability to keep his cool, physically and psychologically, has led to a lot of jokes about how "A C stands for air conditioning." (The reality is that his initials, like Harry Truman's famous middle initial S, don't stand for anything in particular. That's why you sometimes see them printed without periods after them.)

Wharton is known for his ability to keep his temper in virtually all situations. Recalling his long career as a Memphis trial lawyer, he says he tried to remember that "everyone wants a sense of worth, even your worst enemy. Let's face it, the slimiest scumbag has a mother somewhere--juries know that. To the biggest liar, I still said, 'Thank you for your testimony.'"

For the most part, Wharton stayed out of electoral politics until his run for county mayor in 2001. He served on hospital boards and chaired Tennessee's Higher Education Commission, but teaching, representing plaintiffs in trial court and acting for years as the county's public defender was more than enough to keep him busy. Some say it's all those diverse roles in the legal system that have defined Wharton's approach to politics. "Mayor Wharton's ability to build consensus and see all sides comes from his lawyering, from knowing that it's not just your facts that count," says Arnold Perl, chairman of the airport authority and a prominent local attorney who is a Wharton ally.

There has long been an intense, often painful push-and-pull between the city of Memphis and the rest of Shelby County. Most civic leaders agree that the area lacks any sort of consensus about where it should be going, what sort of vision is needed to stem the tide of people and businesses leaving not just the city but the state and going to neighboring counties in northern Mississippi. The city and the county cooperate in some economic areas but feud in others, most recently stalling important efforts to redevelop the Pyramid sports arena downtown and the Mid-South Fairgrounds on the eastern side of the city. "Economic development is just clearly an area where we are encumbered by the bureaucracy," says Blair Taylor of Memphis Tomorrow, a consortium of CEOs of the largest local companies, "and the additional red tape and the resulting slower decision-making that's part of having two separate governments having to collaborate."

Wharton and suburban mayors such as Sharon Goldsworthy of Germantown, who admires Wharton in many ways, disagree profoundly about how best to bridge what Goldsworthy describes as a "Grand Canyon divide" between the city and county view of government. Memphis has offered its residents a long list of scandals, with clear examples of misappropriation of funds and, Goldsworthy argues, a prevailing attitude that the purpose of government is to coddle and protect its own workers. Wharton understands this. "I would be less than honest," he declares, "if I didn't say to you there's a problem of trust, a perception that Memphis is filled with nepotism and crime, and suburbanites don't want any part of that. We can't deny the challenges of the city of Memphis."

Over the past several years, Wharton has received enormous credit for cleaning up and pruning a county government that was once subject to nearly as many complaints about spending abuse and a culture of entitlement as the city of Memphis is today. But Goldsworthy and other suburban mayors argue that Wharton should attempt to clean up the city's act before asking the rest of the county to merge with Memphis. "Memphis has not been able to manage their own money, let alone any money we would give them," says Keith McDonald, mayor of Bartlett, the county's largest suburb. "Our community feels we'll end up paying more taxes and get nothing in exchange."

The argument that suburbs don't want to acquire new debt or take on other problems of the central city is one that has derailed or delayed recent consolidation efforts in Buffalo, Des Moines, Topeka and Pittsburgh. Since merger approval must come via separate majorities in both Memphis and the rest of Shelby County, Wharton can't afford to ignore any significant constituency, even if he is mayor only within the city limits. He insists that the only solution to the metro's stagnant civic culture is to build an entirely new government from scratch. But he recognizes that, politically, it remains a tough slog.

While Wharton is considered a much better salesman for consolidation than Herenton was, there are still some who wonder whether he's making a mistake in giving up his countywide seat in favor of striving to take over City Hall. It's possible that he's built up enough of a reservoir of goodwill out in the county to enable him to manage the merger from within Memphis. But some of the suburban officials argue that, even as the mayor of Shelby County, Wharton's positions have grown more Memphis-centric. "He has a bent and it is towards Memphis," says McDonald, the Bartlett mayor. "I just don't think he's ever walked in the shoes of the suburban communities."

Wharton seeks to remind voters that they'll have plenty of opportunity to weigh the merger idea on its merits because of the painstaking process that will lead up to the vote. A charter commission will craft a merger map, based on the work of task forces set up by Wharton to look at combining specific governmental functions. If he's not able to pull off a pure political merger, Wharton wants at least to consolidate the programs that would fit best together, such as combining the city and county law enforcement agencies.

Wharton is constantly trying to put pieces together. Earlier this year, after winning county approval, he persuaded the Memphis city council to alter the tax incentives used to attract new businesses. He has taken the lead role in coordinating state, local and nonprofit efforts to address the city's worst-in-the-nation infant mortality rate. Even consolidation opponents such as McDonald and Golds-

worthy praise Wharton's work on joint efforts such as emergency preparedness, the distribution of homeland security dollars and the Memphis Metropolitan Planning Organization.

Wharton's emphasis on forging partnerships isn't just a function of his personality or legal background: It reflects the limitations of the relatively weak office of county mayor. In many areas, he has little choice but to serve as a spokesman and a convener, not the sole or direct driver of policy change. Many current Wharton initiatives depend on persuading Memphis officials to apply for federal dollars for which a city, but not a county, is eligible, such as those covering prisoner reentry programs and law enforcement grants. "He has made the most of the position of county mayor," says John Moore, president of the Greater Memphis Chamber of Commerce. "You can make people go your way if you're able to articulate what makes sense."

But there are too many conflicting layers of government and Shelby County itself is simply too diverse--with soybean fields sitting just minutes from crack houses--for any politician to try to ram things through. The result is that at times, because of his deliberate style of diplomacy, advocates on particular issues have accused Wharton of moving too slowly or being a fence-sitter. He himself believes--or at least hopes--that if he gains control of the city, he will be able to move things along more expeditiously.

One way he tries to do that is to find ways to formalize his policy choices--not just to pay lip service to problems by making a speech or even by securing a single year's funding, but by erecting an infrastructure that will allow initiatives to keep their footing over time. "Every project should have a home--nothing should be itinerant," he says. "If you set up a structure and it's good, it will go on. If we did not have a home for that project, it would probably fade."

Toward that end, Wharton has hatched a new idea to raise money for what is perhaps his most vexing current policy problem, The Med. Since his earlier efforts at the federal level have yet to bear fruit, he now hopes to persuade Congress to create a pilot program that would allow for federal funds to flow to the hospital through a regional, rather than state-based, model. Some of the officials in neighboring states, for all their recalcitrance at helping with The Med's finances, insist they are sympathetic. "Shame on us," says Jamie Carter of Crittenden Memorial in Arkansas, "for going along for so long without getting funds to The Med."

Wharton's Shelby County government provided The Med with $31 million in subsidies this year, while the state of Tennessee kicked in another $37 million. But the lack of support from Mississippi and Arkansas still may prove to be the "domino that pushes the whole wall down," says Gene Holcomb, The Med's board chairman. A new management team has begun laying people off, rewriting contracts with vendors and squeezing out other savings that amount to more than $20 million a year. But without reliable multi-government support, hospital officials say, it's not enough. Already, The Med is seeking to extricate itself from the business of underwriting neighborhood health clinics that serve the poorest ZIP codes in Memphis. In a matter of months, Holcomb says, the hospital may have to shut down all but the most essential emergency services. "Shelby Countians are providing more than their fair share," Holcomb says, "but more important, we are declining in our ability to provide care."

Joyce Avery, who chairs the Shelby County Board of Commissioners and would replace Wharton as county mayor if he wins election in Memphis, says she's met with every mayor inside a 100-mile radius to point out the dollar amount of services their residents have received at The Med. Avery says that "Arkansas is just the pits at paying for their indigent patients." Mississippi hasn't done much better. In 2008, Mississippi sent The Med $3 million. In the most recent fiscal year, it sent nothing at all. Legislators there met in special session twice in 2009 to plug a $90 million shortfall in the state's Medicaid budget--a hole that's bound to grow as federal stimulus funds run out. "Certainly, Mississippi wants to do everything it can for The Med," says Francis Rullan, Mississippi's Medicaid spokesman, "but at this point, we're struggling just to be able to pay our own providers in the state."

Kenneth Robinson, the Shelby County health officer and former health commissioner for the state of Tennessee, says The Med would not enjoy the support it does from the state or the county "if it had not had the passionate, consistent educational advocacy that it's had from our county mayor." Robinson says Wharton's personal lobbying among other mayors and politicians across state lines has helped The Med make the case for more funding, which he hopes it can win by demonstrating the success of its new austerity measures.

Robinson chaired a task force on The Med that Wharton put together in his own characteristic fashion. Few politicians have ever shared Wharton's ardor for task forces and special committees. In this case, the purpose of the task force was not to forge grand new policies, but instead to create a mechanism for bringing onto The Med's team top health executives and business leaders who still might need to be convinced of the essential need to support the institution, despite the city's large number of other hospitals.

Wharton cheerfully recognizes his dependence on other actors, but also expresses frustration about constantly having to turn to them for help. That's one obvious reason why he's seeking to promote not just regional cooperation but the establishment of a regional government. Last year, he had to scramble to make up lost millions when the Memphis city council decided it no longer wanted to abide by a 40-year-old health funding agreement. "The weakness is that it's subject to the foibles of politics and personality," he says. "If I'm getting along with the mayor of the city, we're fine. If we fall out, I lose the money." And if he happens to be the city mayor--well, that's likely to make up the next chapter of the story.