Dir: Michael Moore. US. 2007. 123 mins.
If it works, don't fix it. Michael Moore's passionate, bullying, gag-laced approach to the 'j'accuse' documentary worked a treat in Bowling for Columbine and Farenheit 9/11 - and it works even better in Sicko, his investigation of the US public healthcare system. Moore doesn't change his methods - he still plays to the gallery, and fingered corporate or government culprits are still given little or no right to reply.

This time round, Moore simply chooses an easier target - an injustice that anyone who believes in human solidarity, whatever their political affiliation, is going to have to work hard to disagree with. Unlike gun control or US involvement in Iraq, the country's insurance-based healthcare model is an issue that daily affects every single American, and the consensus that something is wrong with a system that lets people die if they're not properly covered (Moore documents a number of such cases) breaks down a little less along political lines, at least outside of Capitol Hill and state legislatures.

Whether this will mean that Sicko will reach out beyond the Moore faithful on home territory is still debatable; his unsubtle methods will still attract accusations of bias from the anti-Moore camp (of which more later). But Moore knows how to generate publicity, and the film's final coup - taking a group of 9/11 volunteer rescue workers first to Guantanamo Bay, then to Cuba, in search of the medical treatment they have been denied back home - will create a huge media buzz (which has already been set humming by news that the US Treasury Department is investigating Moore for breaking the US trade embargo with Cuba).

Abroad, especially in Europe, Sicko will shock and comfort in equal measure - if we were being uncharitable, we might view his decision to contrast the US system with the free health care offered in Canada, Britain and especially France as a feel-good gift to audiences and distributors in those territories. But the points Moore makes here are (mostly) well-founded - and managed, as always, with a vein of irony that makes it difficult to dissent.

We all know that behind his lumbering persona and his Lieutenant Colombo play-dumb questioning style, Moore is one smart cookie: and the smart move he makes in Sicko, stated at the outset, is not to focus on the problems of the 45 million Americans who can't afford to pay for health insurance, but to examine the way the system has failed the 250 million who do pay for cover.

Edited for maximum effect by, among others, Dan Swietlik (An Inconvenient Truth), Sicko mixes voice-over factoids with walk-and-talk interviews. We meet a man who had to choose which of two fingers should be sown back on after an accident, because he couldn't afford to pay for both; and a woman who received a bill from her insurance company following a car crash because the ambulance ride had not been pre-approved.

Gradually the main players are sketched in - the big insurance companies like Horizon Blue Cross or Kaiser Permanente, whose practices are revealed via interviews with whistle-blowing former employees or associates, including a medical reviewer who, she says, was employed to save the companies money by turning down applications - thus, effectively, killing people.

Jaunty or mock-heroic music (including, at one stage, the Star Wars theme) and comic insets of archive footage (like the marching troops and smiling Soviet peasants who are used to illustrate an ironic voice-over point about the dangers of 'Socialised Medicine') keep the mood from getting too bleak or strident.

After a sideswipe at Hilary Clinton (accused of burying her healthcare-for-all campaign after receiving campaign contributions from the health industry lobby), Moore is on the road - in Canada, Britain and France, whose welfare states are contrasted with the American private system. Moore interviews a British doctor who drives an Audi and lives in a million-dollar house, while in Paris (cue Moore lumbering along a boulevard to the strains of 'Je t'aime') he has dinner with a group of US ex-pats who gush (sincerely, it should be said) about France's state-subsidised health and childcare facilities.

Of course, Moore paints a rosy picture: one example of his editorial sleight of hand is the way he moves straight from praising the British NHS (National Health Service) to criticising the way US university students are saddled with debt - without mentioning that their British counterparts have long had exactly the same student-loan millstone around their necks.

Then comes the Cuban punch: taking a group of ailing 9/11 volunteers across to Guantanamo Bay ('the one place on American soil that has free universal health care') and then to Havana to get proper treatment. Much like the Walmart scene that wraps Columbine, it will inevitably attract accusations of manipulation. And of course, it is manipulative: Moore needs this pay-off, just as he needs the upper-cut revelation that he sent an anonymous cheque to Jim Kenefick, the man who runs Moorewatch - the main anti-Moore website - so that he could pay his wife's medical bills and keep the site open. (It's easy to sympathise with Kenefick's reaction to the stunt, posted on his website: 'He paid $12,000 so he could manufacture a 'gotcha' moment in his film. Sounds pretty cheap to me.')

But this is what distinguishes a Moore film from a balanced, nuanced documentary like The Fog of War. It may not be subtle, but it makes for great, heart-on-sleeve cinema.

Production companies
Dog Eat Dog Films

International sales
The Weinstein Company

Kathleen Glynn

Dan Swietlik
Geoffrey Richman
Chris Seward

Music supervisor
Jim Black