How much you gain from Sicko depends on where in the world you're watching it from. Anyone inside the United States may wonder what all the fuss is about - sure, it's not a perfect system, but it's all they've got. Moore doesn't so much tend to his subject as deliver a crippling and fatal diagnosis: his opponents will no doubt claim this is more liberal lip-flapping without little offered in the way of feasible solutions. However, if you're lucky enough to be watching Sicko from a country with free universal healthcare, then it becomes a real horror show: a damning indictment on a fatally flawed system, one that makes the rich richer and the poor... well, dead.
For the uninitiated: If you're an American citizen and you get sick or injured, then the state will not pick up your cheque - either you pay for your treatment yourself, or it's covered by your health insurance. So, accidentally chop off a couple of fingers like one poor uninsured soul did, and you're left with a choice: $12,000 to have the ring finger re-attached, or $60,000 for the middle finger. A few cuts and scrapes won't put too much of a dent in the average wage-earner's pay packet, but get diagnosed with the big C and watch the bills stack up - health insurance only goes so far, and that's if you've managed to avoid one of the several hundred reasons they have for refusing you cover. It's a system that literally puts a price on human health.
Having been accused of being bigger than the issues he argues, Moore wisely stays out of the limelight here, instead letting others do the talking for him. Some interviewees lay on the syrup a little thick - the suggestion of one widow that her husband was refused treatment because he was black doesn't quite ring true - but otherwise, the confessions and allegations Moore has uncovered cut razor deep. One former employee of an unnamed healthcare company admits it was his job to exploit flaws in customers' insurance policies so as to deny them medical assistance, saving his company money. Another healthcare executive admits the less patients she assisted financially, the bigger her bonus was come the end of the year. It's almost beyond belief that the richest nation in the world can treat its people so poorly, and Moore uses no cutesy animations or sugar-coating to sweeten the pill.
Moore steps into the frame in the movie's second half, travelling to Europe to see how free universal healthcare really works. Predictably, it's a rather rose-tinted colourisation of the truth, although given the norm back home, Moore can perhaps be forgiven for his over-enthusiasm. The NHS is painted as a flawless system (to mention waiting lists, cleanliness and staffing issues would detract from his argument) and had Moore spoken to an NHS nurse or someone lower down the chain, then the responses he received would no doubt have been different. However, UK viewers may shift uncomfortably in their seats when they realise just how good they have it when compared to the United States. Suddenly sitting in a waiting room for a couple of hours doesn't seem quite such a drag.
Always a jovial host, even when discussing matters of grave importance, Moore really raises his game when he ventures to France - where it seems everything is free. Healthcare, childcare, laundry... Chatting with a group of ex-American citizens now residing in Paris, Moore discovers that the French enjoy a quality of life that makes America look positively barbaric. "It's almost enough to make me drop my freedom fries," says Moore. Almost.
In that vein, Moore can't resist a few digs at the Bush administration here and there. Upon finding out that the only free healthcare available on American soil is at Guantanamo Bay, he gathers up a bunch of poorly 9/11 rescue volunteers and heads to the camp. A cheap shot, you might think (it's certainly fodder for the 'Michael Moore Loves Terrorists!!!' crowd) but the subsequent trip to Cuba shines light on the cavernous gaps between American healthcare and that of the Rest Of The World. One of Moore's colleagues breaks down in tears when she's told the inhaler she pays $120 for back home only costs a few cents in a Cuban pharmacy. The section ends with Moore's 9/11 heroes receiving a salute from the town's fire-fighters - touching, yes, but it's in the wrong movie.
Like Al Gore's An Inconvenient Truth, some of the facts and figures may have been fiddled to suit the argument - people like Moore himself will tell you not to believe what you see at face value - but whether you think it's biased or unbalanced, there's no denying it's an issue worth debating. Moore dissects his subjects with almost clinical ease, leaving you in no doubt that the current system favours the wealthy and utterly fails almost everyone else. More humble than Fahrenheit 9/11 and as enthralling as Bowling For Columbine, Sicko is another target hit square on the nose for America's premier documentalist.