Written, directed and produced by Michael Moore
In cinemas nationally from 9 August
Sicko is Michael Moore's long-awaited follow-up to his phenomenal 2004 documentary Fahrenheit 9/11, in which his cinematic guns blazed at the twin targets of US President George Bush's illegitimate presidency and the US invasion of Iraq. The refusal of either villain to lie down and die, despite the heavy battering they took, prompted some commentators to speculate that Moore's days were over and he'd shrunk into obscurity.
The custodians of the Academy Awards declined to bestow an Oscar on Fahrenheit. They'd learned their lesson after Moore famously used his Bowling for Columbine victory as a prestigious stage from which to denounce the US president and his "fictitious war". Far from "going into hiding", as some detractors might have hoped, Moore has been working on Sicko, a compelling and alarming examination of the disastrous US health-care system.
The project actually began in 1999, but the Columbine High School massacre and the US-led invasion of Iraq waylaid Moore for several years before he could see it through to completion. Lacking the ready-made drama of a high school massacre or the 9/11 terrorist attacks, the film seems to start somewhat shakily, and we're unsure of where it's going. But Moore's trademark satire and archival revelations soon emerge, creating a profound and surprising film, leading us to question the fundamental principles on which an entire society functions.
Sicko is probably Moore's most radical production to date and one which will make you hate Grey's Anatomy with all its "glamorous" but totally phoney representations of health care in the US.
The US health-care system — the word "care" seems far too generous after seeing this film — is so exclusive that 45 million US residents are today highly vulnerable, completely without medical insurance. "But this movie's not about them," says Moore. Rather, the film reveals how the private health insurance companies shatter so many lives among the "quarter billion Americans who do have insurance".
The personal tragedies revealed here are saddening and maddening. The push to turn a private profit out of every person's health management leads to 18,000 avoidable deaths annually in the US. Sicko's revelation of such alarming statistics and case histories has raised the usual chorus of anti-Moore indignation following its release in the US. But, as before, Moore has managed to comprehensively rebut all his critics by publishing on his website supporting evidence from reputable sources for every one of the film's claims.
But then again, the careful presentation of a well-researched factual history has never been Mike Moore's raison d'etre. His films are hard-hitting, emotive polemics, using satire and stunts as clarion calls to his fellow US citizens to wake up and start talking about social change.
We endure a distressing scene in which a hospital forcibly discharges an elderly woman who is clearly still in need of medical care. A taxi driver is instructed to shove her out into the street, disoriented and afraid outside a homeless shelter.
"Who are we? Is this what we've become?", Moore pleads.
Having climbed over the other side of the fence of privilege in his own country, Moore sets off to see what happens abroad. The universal health-care systems that he discovers in Canada, France and Britain contrast with the grotesquely unequal US system. Moore's heart is in the right place here, but astute viewers might question the rosy glow that he brings to the modest remnants of Western social democracy.
We're only introduced to comfortable, middle-class professionals abroad. A young doctor in Britain tells us that his job in the public hospital system has made him well-off, but he would have to look elsewhere if he was the type of person who wanted medicine to make him obscenely rich.
But even among this rosy glow we can discern some valuable political lessons.
A French doctor echoes the powerful motto of the recent film V for Vendetta when he tells us that what prevents the French government from getting away with introducing a US-style health system is their fear of the power of mass political protest.
Moore does a gloss-job on the US Democratic Party, which is unfortunately altogether predictable from him. He revisits the early years of the Clinton presidency, during which first lady Hilary Rodham Clinton headed a health care reform task force. It's a valuable lesson to see the way the giants of the health industry put up almost hysterical resistance to any suggestion of reform, but Moore's unquestioning approach gives us the false impression that the Democrats wanted to usher in a grand new era of universal health care in the US.
According to Barbara Ehrenreich, writing in the Nation, "the bottom line is that despite [right wing] charges of 'socialised medicine', Hilary Clinton's plan would have maintained the nation's largest private insurance companies' death-grip on American health care". Indeed, as a declared candidate seeking the Democratic Party's nomination for the 2008 presidential elections, Hilary Clinton now leads the field in terms of political donations from the health industry.
For all his radicalism and bravado on behalf of the working class, Moore remains thoroughly tunnel-visioned on the question of party politics in the US. When questioned about the supposedly "controversial" nature of his work, Moore begged to differ:
"These days, I get a lot of Republicans stopping me on the street and apologising to me. They now see that [Fahrenheit 9/11] was trying to warn them the Emperor has no clothes. At this point, I'm very squarely in the middle of the mainstream majority."
But those Republicans won't be so enamoured with the overriding message of Sicko, which is that the people of the US should take inspiration from alternative social systems abroad.
The final stop on Moore's worldwide tour of health care systems is an inspiring visit to revolutionary Cuba, where free health care is provided as a basic human right to every citizen at a fraction of the cost in other countries. It's no exaggeration to say that the final part of Sicko showcases the moral power of socialism, by highlighting the progressive gains of the Cuban revolution. That sort of conclusion sits strikingly outside the "mainstream majority" of US political opinion and is the most surprising aspect of the film
Cuba is a small and relatively impoverished nation. Yet today it sends over 25,000 doctors annually to provide humanitarian medical aid in no less than 68 of the world's neediest countries. Struggling under a US economic embargo for over 40 years, Cuba's revolutionary system shames its rich and powerful neighbour with an infant mortality rate and life expectancy at birth equal to the US.
It would be spoiling the experience of seeing the film to reveal why Moore decides to go to Cuba, how he gets there and exactly what happens. Suffice to say Sicko's Cuban finale manages to link together the "war on terror" with the struggle for social alternatives to the ravages of US capitalism. Moore also manages to pull off some unexpected, humbling diplomacy between the two supposed enemy nations.
And there's no-one else other than Michael Moore who can do all that in the one film, while making you laugh and cry at the same time.