There is at the moment such a roaring trade in anti-Michael Moore documentaries - the recent Manufacturing Dissent: Uncovering Michael Moore following Michael Moore Hates America and Celsius 41.11 - that DVD stores will soon be allotting them an entire section of their own. I'd suggest stocking them under "Golden Oldies". After all, it is nearly 20 years since Harlan Jacobson discredited Moore's 1989 debut, Roger and Me, in Film Comment magazine, ticking off that picture's various conflations, distortions and outright fabrications. Back when Moore was unknown, and a smash-hit documentary something of an oxymoron, this was an important revelation. Now I tend to think that if you look at this camera-hogging egomaniac with his gee-whizz shtick and facile editing tricks and still believe everything he says, you need to reduce your medication. We're talking about a grown man in a baseball cap. What more do you need to know?
Headgear notwithstanding, Moore remains a force for good - even if, in film-making terms, he is often also a force for the mediocre. His new picture, Sicko, analyses the state of America's health-care system, and asks why the nationalised care that has been so effective in other countries has never been implemented in the US. The short answer, as Moore shows in a stinging shot that attaches a price tag to every member of US Congress according to the pay-offs each has received from health-care maintenance organisations (HMOs), is that there's simply too much money in the American Way. Moore traces this corrupt system from Nixon to the current administration, pausing to document the metamorphosis of Hillary Clinton from would-be health-care reformer into HMO lapdog and to take a trio of 9/11 volunteer workers to Cuba for the tip-top treatment that they can't get at home. He coaxes anecdotes from a few of the 50 million people without health cover, and others whose treatment was cut or denied by their insurer on a technicality.
There is CCTV footage of a dazed patient, ejected from a hospital when her funds ran out, being dumped by taxi in downtown Los Angeles - a common occurrence, apparently - and sleepwalking off into the road. And there's distressing testimony from a woman who pitched up at a hospital with her sick daughter, only to be turned away because the hospital was not one approved by her health-care company; the child died shortly after reaching a designated institution. It's a shocking story, but I would like to have eavesdropped on the conversation in which Moore convinced this grieving mother that her words were not quite dramatic enough on their own. What if she were interviewed in a bustling playground as she leafed through a family album, with the sounds of joyful, childish laughter amplified on the soundtrack? It's promising but it still needs that cherry on top. Would a close-up of an empty swing swaying in the breeze be too much?
It's commendable that Moore is introducing serious issues into mainstream cinema, and I get a warm, fuzzy feeling just thinking of his interview here with Tony Benn playing to audiences at multiplexes in US shopping malls. Yet the film panders so enthusiastically to the easily distracted viewer that it risks patronising those who don't require a ladleful of sugar to help the medicine go down.
Moore walks a thin line between rendering the material accessible and trivialising it. The jaunty music that offsets disturbing statistics is used so frequently that it acquires anaesthetic properties, just as the sharpest arguments are dulled by Moore's belief that if a point is worth making, it's worth making repeatedly in a sarcastic, self-satisfied voice. The effect is like being nudged in the ribs non-stop for two hours: your sides ache, but for the wrong reasons.
Sicko may prompt snorts of derision, if not sly chuckles, from British audiences during a section where it sings the praises of the NHS. Moore is broadly correct to celebrate NHS principles; the Clostridium difficile outbreak might have stolen a march on his moist-eyed sermonising, but even that is dwarfed by the 18,000 deaths that occur every year in the United States among those without health-care cover. Rather, it's the adoring shots of empty waiting rooms at a London hospital that will really get the goat of anyone who still arrives punctually for a 9am appointment, full of the naive, childlike hope that he or she will actually be seen before dusk.
Pick of the week
Mr Brooks (18)
dir: Bruce A Evans
Kevin Costner as a serial killer. Not as scary as Dances With Wolves.
dir: John Carney
Low-budget love story about an Irish busker and a Czech singer.
Tim Burton’s The Nightmare Before Christmas 3-D (PG)
dir: Henry Selick
The 3-D re-release of this warped Halloween-into-Xmas fantasy is becoming an annual event.