Michael Moore takes a sometimes blunt scalpel to the US health system, writes Michael Dwyer

MICHAEL Moore once again ladles out the humour in equal measure with the message in Sicko, his first documentary since Fahrenheit 9/11, the 2004 Palme d'Or winner at Cannes. As a bridge between the two films, Sicko opens for laughs as the present incumbent of the Oval Office issues a Bushism.

Moore's target this time - the US health care system - is a subject that will resonate with audiences in this country, where the HSE is rarely out of the news for all the wrong reasons. It may prove a small consolation to Irish viewers that the system in the US - where five out of every six people have taken out health insurance - is far worse, as illustrated in Sicko.

Adhering to his now familiar formula, Moore draws on statistical data and human experience. His website request, "Send Me Your Health Care Stories," yielded more than 25,000 "horror stories" within a week of being posted. Then, he claims, he received thousands of e-mails from people working within the system.

From the evidence Moore presents, it's hard to disagree with his depiction of the villains in his film: the US health insurance industry as callous and avaricious; the pharmaceutical companies as exploiters grossly overcharging for medication; and the political establishment as being in their well-lined pockets.

Among the testimonies Moore captures on camera is that of a man who has accidentally severed two of his fingertips and is quoted a charge of $12,000 to restore the middle finger and five times as much for his ring finger. Survivors of a car crash are charged extra for ambulance journey because it was "not pre-approved".

And Los Angeles hospitals are reported to be depositing homeless patients back on to the streets.

Even for the 250 million Americans with health care insurance, there are numerous legal loopholes and obstacles buried in the small print and waiting to ambush them. Care is far from the minds of the heartless bureaucrats at insurance companies, and former staff members reveal the tricks they played and how they were paid bonuses when they succeeded in turning down claims.

One woman tells how her baby daughter was refused emergency treatment at a hospital because her health plan covered treatment only at another hospital. The daughter had died by the time she was moved there. And Moore details the campaign waged by the insurance industry against Hillary Clinton's campaign for affordable health care. He claims insurance spent more than $100 million to stop her reforms, and that their biggest achievement was "buying Congress".

Moore narrates the movie with his characteristic combination of outrage and jocularity but, unusually, he stays off screen for much of the time. His showmanship comes to the fore towards the end when he notes that the only place on US soil that offers free health care is Guantanamo Bay. He cheekily leads 9/11 rescue workers there by boat to seek the "same medical treatment for them as Al Qaeda".

Moore is as selective as ever as he loads his case in this polemic- as-entertainment, which results in a series of naive pronouncements on the state of the health systems in other countries. At the world premiere of Sicko at Cannes this year, some of the biggest laughs came when Moore uncritically extolled the British National Health Service - and the French 35-hour working week with all its associated benefits - as paragons that the US should aspire to emulate.

Nevertheless, the very best place in the world to live, Moore concludes at the end of his global tour, is Cuba - although there's no sign of him moving there.