In his latest film, Sicko, documentarist Michael Moore (Roger & Me, Bowling for Columbine, Fahrenheit 9/11) uses his exceptional talents as writer, director, and provocateur to take on the US healthcare industry, in particular the health maintenance organizations (HMOs), the companies that regulate the payment of healthcare services. In his efforts to prove that socialized or government-run medical systems are superior to the existing US system of privately funded medical care, in which HMOs sell medical insurance to qualifying customers, Moore effectively compares the US system to those of Canada, Cuba, the UK, and France. Sicko is less dramatic and more humorous than Bowling for Columbine or Fahrenheit 9/11, but it’s just as effective in delivering Moore’s message that all is not well in the US, and that Americans would do well to look elsewhere for solutions to their social problems.

Sicko begins in low-key fashion with vignettes illustrating the effects of a lack of health insurance on individual lives. Two examples stand out: In one, a man who had sliced off two fingers while using a power saw could afford to have only one finger reattached -- the other would have cost him $60,000. In the second, a retired couple is forced to sell their house and move into their daughter’s computer room because their health costs have wiped them out and ended their quest for the American dream. Moore then reminds us that his film is not actually about these people, or the 40 million or so Americans without medical coverage -- it’s about those who actually have coverage.

Moore introduces us to the HMOs and documents their growth in profitability, which has resulted -- we logically assume -- from money that has been extracted from actual healthcare. Using documentary film footage, he gives us a colorful history of HMOs, beginning with the HMO Act, passed during the Nixon administration, then the social and political environment prior to their establishment -- all the way back to the fear-mongering that took place in the 1950s, when the idea of universal healthcare administered by the government was considered the first step toward communism. By linking HMOs to excess corporate profits and to disgraced right-wing politicians such as Nixon and Senator Joseph McCarthy (through references to the anticommunism/witch-hunt movement of the 1950s), Moore has us on his side early on, making it much easier to convince us there must be a better solution than HMOs.

One of the more effective techniques employed in Sicko and in Moore’s other documentaries is to build up the opposing arguments to his thesis, then debunk, ridicule, and contradict them with facts and dissenting anecdotal evidence from interviewees. After such a thrashing, the alternate point of view always seems so sensible.

Moore also carefully promotes his image as a common man taking issue with corrupt "suits." Despite his own considerable financial success, Moore still dresses like a Midwestern blue-collar worker, and pretends to be far more simple and naïve than he actually is. In the UK, Moore asks a British couple who are leaving the hospital with their newborn, "How much did your baby cost?" When they state that they have paid nothing, he expresses shock. Moore plants the idea in our minds that if an American couple cannot pay their hospital bill, then perhaps they cannot leave with their baby.

Because Moore has been criticized for playing loose with the facts, I used his depiction of the Canadian health system, about which I have good knowledge (I live in Canada), to gauge how accurately he portrays the British, French, and Cuban medical systems. Though Moore fails to mention some long waits in hospital emergency wards and the shortage of family physicians, Sicko does accurately present the high quality and universal access of medical care in Canada. I can only conclude that he’s done an equally fair job of representing the French, British, and Cuban systems.

If there is a weakness in Sicko, it is that Moore interviewed no one who was satisfied with the US’s current private system of healthcare delivery. Surely there must be millions -- besides the HMOs and their lobbyists -- who are satisfied with the status quo. The advantages of the current system are never discussed, but then, Moore’s documentaries have never been about presenting a balanced argument.

Despite Sicko’s shortcomings, I left the theater thoroughly entertained, yet confounded by the idea of having a middleman -- the HMO -- whose sole purpose, it seems, is to extract as much money as possible for itself while channeling funds from the public to the healthcare practitioners. Sicko made me more fully appreciate the system we have in Canada. And you can be sure that, the next time I travel to the US, I’ll be loaded with medical insurance.

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