Man of the people or America 's very own Great Satan? Wherever you stand, you have to admit Michael Moore has a gift for making a point.
Perhaps that's understating the matter. When the celebrated (and reviled) filmmaker pulls up in a fishing boat outside the US detention camp at Guantanamo Bay and announces via bullhorn, "I have three 9/11 rescue workers! They just want medical attention! The same you're giving Al-Qaeda !," we are witnessing a master gadfly at the top of his game. Whether we can't breathe because we're laughing too hard or because we feel like we've been punched in the gut is moot.
"Sicko" is Moore's best, most focused movie to date -- much more persuasive than the enraged and self-righteous "Fahrenheit 9/11 " -- and not just because the director turns the dial down on his own faux-folksy persona. Moore has a thesis he can get his arms around this time. Resolved: The US health-care system is a disaster, built to punish the sick and enrich corporations. Other countries do it better -- a lot better. Why is that, and how do we change? It's only on the last point that Moore falters.
Go ahead, feel smug; you live in Massachusetts, where affordable universal insurance becomes law on Sunday. "Sicko" unleashes its scorn not just on insurance companies, but on HMOs, Big Pharma, and the politicians they own. The movie builds its case from the ground up, with anecdotes of average Americans so cruelly abused by the system the only response is the laughter of disbelief.
One man lost two fingers to a tablesaw, then was told by doctors he could afford to have only one re attached, so would he prefer the middle or ring finger? A woman was denied the cost of post-car-crash EMS care because it hadn't been pre-approved. Another woman was told she must give back the money that paid for her operation because she hadn't disclosed a pre-existing condition: a yeast infection years earlier.
Those are the more grimly entertaining stories. Others just make you want to cry, and for once you don't feel Moore is exploiting other people's tragedies (any more than they want him to, at least). Some people were willing to use the director right back; there's a tart little segment about a father desperate to get a second cochlear implant for his baby girl (the insurance company would only pay for one), who drops Moore's name in a phone message to the claims department. Bingo -- the implant is approved.
"Sicko" features interviews with former insurance company employees who describe quotas for claims denials and bonuses for anything above quota -- the system appears rigged specifically to not provide help to those who need it. Moore talks to a doctor whose signature is on a series of denials to a woman suffering from a brain tumor; it turns out the signatures are stamped without the doctor ever reading the claims.
How did we get here? "Sicko" reaches back to the Nixon administration for a fascinating secret-tapes conversation in which aide John Ehrlichman urges the president to get behind Kaiser Permanente's HMO approach to health care. (The next day, Nixon announced the HMO Act of 1973. ) Moore also brings up Hillary Clinton's doomed attempt to pass a universal health-care bill the way you might discuss an ex who stood you up; he acidly notes Senator Clinton is now the second-largest recipient of contributions from health-care corporations.
The film's bitterly funny activist vaudeville truly begins when Moore travels abroad to see how different nations take care of their sick and injured, beginning with a woman who sneaks over the border to Canada for health care. "We're Americans," he deadpans. "We go into other countries when we need to. It's tricky, but it's allowed."
It's when "Sicko" ventures across the channel to France that Moore and the movie swoon most amusingly. Three months' paid leave for cancer survivors! Doctors who make house calls! Health-care nannies who do the washing for new mothers! "No one from the government comes to do your laundry in America," gripes the director.
Actually, back in America, facilities are seen dumping those who can't pay onto the street in their hospital gowns -- Moore has the surveillance-cam footage. The United States is ranked 37th in the quality of its health-care system, "just above Slovenia ." We have the highest infant mortality rate in the Western Hemisphere.
Does Moore present his case even handedly? Not remotely, which is one reason he's the rock star of nonfiction moviemakers. In the grand tradition of troublemakers from Thomas Paine to Thomas Nast to Jacob Riis , he dares to have a point of view and the effrontery to press it without tact. He'll fudge a fact or two in the interests of what he considers the greater truth, and his critics are happy to call this lying.
This can and has (and continues to) get him into trouble, and the film's walk-in visit to a Cuban hospital seems a medical miracle too rose-colored by half. Perhaps we'll see all the outtakes in the DVD, including whatever it took to set up this sequence.
"Sicko" has so much fun pointing out what's wrong, in fact, that it can barely be bothered to specify what might make things right. There are plenty of universal health-care proposals out there -- put forth by presidential candidates, various states, foundations -- but Moore knows the details would cramp his style. His genius as a provocateur is his failure as a policy analyst, and that's the American way, too: Put on a good show but leave the particulars to someone else.
Still, for once the investigation seems to have fueled Moore's outrage rather than the other way around. Whatever you call his movies -- agitprop, advocacy entertainment, Commie propaganda, the Truth -- "Sicko" is built to persuade. It succeeds by making us ill with laughter and with shame.