There's probably nothing more important to the day-to-day lives of Canadians than our health-care system.

It is an essential service we will all need at some point in our lives and many times when we do, we will need it very badly.

So the meeting of Canada's health ministers in Halifax on Friday is the opening round in what will be a difficult and even messy negotiation between Ottawa and the provinces about the future of the system.

The federal provincial health accord, under which Ottawa transfers money to the provinces and the territories, was signed in 2004 when Ottawa agreed to hand over $41 billion over 10 years.

The provinces were happy to take the money. They kept the system together despite some slippage in single payer equal access principals, but did not deal seriously with the issue of costs -- which are rising at levels everyone agrees are unsustainable.

This has led Ontario Premier Dalton McGuinty to say that what the country needs is nothing less than a survival plan for medicare.

In Ontario, health care eats up almost half of the province's total spending every year, and the result is about the same in the other provinces.

In the past 15 years, health-care costs have grown much faster than the Canadian economy, leaving some to estimate that if the present growth continues, it could eat up 80 per cent of provincial spending in another generation, leaving provinces little to spend on anything else.

Another nation-wide issue will be the need to redesign the system to meet their requirements of a fast-aging Canadian population. In some provinces, half of the total health-care spending already goes to deal with the elderly.

In the rhetorical ruckus, which is bound to develop over how to reduce costs, much of the debate may focus on whether the system will permit more health-care entrepreneurship and private-for-profit, medicine.

Should governments let up on their monopoly on control of delivery of essential services?

Former Reform Party leader Preston Manning, now head of an Alberta think tank, says Canadians should keep an open mind on this.

Roy Romanow, former premier of Saskatchewan -- where Canadian medicare was born --says the outcome of these negotiations will be a test of Canadian values.

Both of these men will be sought-after players on the sidelines when the premiers meet in January to start hammering out what they'll demand from Ottawa.

They will both appear on Question Period this Sunday. Also joining Kevin Newman and me, Finance Minister Jim Flaherty.