In this paper the author examines, through a case study of a hospital merger in Boston, MA, the ways in which a locally scaled union strategy can shape privatization. She first examines recent economic changes in the US hospital industry, which have resulted in a record number of mergers, closures, and conversions. A case study of the merger between a public hospital, Boston City Hospital, and a private hospital, Boston University Hospital, into the private, nonprofit, Boston Medical Center is presented to demonstrate the ways in which unions can participate in setting the terms of such mergers. The strategy of one labor union local in particular, the Service Employees International Union (SEIU) Local 285, is examined in regard to protecting both the provision of public healthcare and the conditions of employment during and after the process of privatization. By utilizing a local strategy and waging a highly public campaign, leaders of SEIU Local 285 were able to build coalitions with other labor unions and public healthcare advocates and played an instrumental role in setting the terms of the merger. As a result, the final merger agreement contained significant protection for quality public healthcare and labor practices favorable for workers. Unions that previously represented public sector workers now represent private sector workers, and wages for all employees moved upward as part of the agreement. In addition, the new private sector entity was charged with what had formerly been a public sector mission. In effect, although the public hospital was ultimately privatized, the private sector was restructured by local level, public sector union activism.
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