TORONTO - The conversation Premier Dalton McGuinty said he wanted to have about Ontario's health-care system seems to be turning into a shouting match.

Groups representing health professionals and hospital workers are less than thrilled with the Liberals' proposed changes to hospital funding, with one union likening McGuinty to a Marxist revolutionary with a business degree.

The government's pledge to "pursue a path of constant reform" on health care is sending a chill through the workforce, said Michael Hurley, president of the Ontario Council of Hospital Unions.

"It's like we're working in a health-care system run by Leon Trotsky with an MBA," he said.

McGuinty is taking a page from the Bolshevik leader by advocating for a permanent revolution in health care in Monday's throne speech, Hurley said.

If the Liberals aren't careful, Ontario could return to the kind of instability and labour unrest that plagued the Conservative government of Mike Harris, Hurley said.

"I think we're heading into a period of some confrontation in the health-care sector, I do," he said. "What that looks like, I'm not sure."

The Liberals' throne speech promised to standardize practice guidelines to avoid unnecessary procedures that drive up costs, modernize Ontario's outdated hospital system and make health-care providers and executives accountable for improving patient care, such as tying their bonuses to hospital performance.

They also proposed to have more hospitals move to so-called "patient-based" funding. Under that model, hospitals would narrow their range of services with the aim of doing surgeries and treatments more cheaply than their rivals. Those who can do it cheaper would get additional cash from the government.

The Liberals are setting the stage for rural and northern hospital closures and laying the groundwork for a private hospital system, critics charge.

"When it comes to health care, I think Mr. McGuinty's already had his conversation with right-wing Americans from south of the border," said New Democrat Peter Kormos.

"He is importing U.S.-style, pro-privatization competitive bidding for our hospitals. That's going to mean more emergency rooms being shut down, that's going to mean more core hospital services being eliminated and people being forced to travel to big cities."

When a similar plan was introduced in the United Kingdom about a decade ago, it led to a host of new administrative costs and privatization of hospitals services, Hurley said.

"When you start to fixate on price in hospital services ... when you commodify them and bid for them and win the market for them, you set up an environment that is open to the private sector," he said.

But Ontario needs to have a "conversation" about health-care if it's to clamp down on skyrocketing costs that are already eating up 46 cents of every dollar the government spends, McGuinty said.

"I think everybody ... they have some sense of the financial challenges associated with health-care costs," he said Wednesday.

"I think there's a lot of goodwill out there. And I think it's going to take a lot of work - and it's not the kind of thing that we can do overnight - but I think it's something that we owe our kids and our grandkids."

Ontario hospitals are already the most efficient in Canada, with the fewest number to population and the shortest lengths of stay, Hurley said.

Yet cash-strapped hospitals across Ontario are cutting nursing positions to re-balance their budgets, said the Ontario Nurses' Association.

Cindy Sandercock, a 44-year-old nurse at Northumberland Hills Hospital in Cobourg, Ont., said she's concerned about plans to cut 26 beds and close the hospital's diabetes clinic.

"It makes me worried for the patients, and it saddens me really that nursing hours and patient-care services are being cut in order to balance the budget," she said.

"I think the government needs to fund the hospitals appropriately and I'm concerned that these small community hospitals, northern hospitals are going to ultimately suffer. And well, the bottom line is that the patients will suffer."

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