Ou Est Mon Muck Rake? Enfant terrible Moore hits Paris to hammer health care.

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Michael Moore’s sharpest, best-sustained film, Sicko is a devastating critique of the U.S. health-care system that shouldn’t worry the American Medical Association all that much. The reason the polemic won’t have much practical effect is clear almost immediately: The film opens with Dubya’s famous gaffe about obstetricians and gynecologists who are not able to “practice their love.” As usual, Moore can’t resist tweaking his opponents, even when such digs distract from his central argument.

That argument, as you can probably guess, is that the practice of medicine in the United States is meaner, pettier, and just plain worse than in other countries—in particular, Canada, Britain, France, and, yup, Cuba. This is probably true, or rather, partially true. Characteristically, Moore skips the “partially” bit, accentuating the positive whenever he’s outside the United States. He finds a Michigan woman who pretends to be the common-law wife of a Canadian so she can get medical coverage, a British doctor who’s entirely satisfied with his National Healthcare Service salary, and Americans in Paris who strongly endorse France’s medical bureaucracy. For his biggest stunt, Moore takes some volunteer 9/11 rescue workers to Cuba for help with their damaged respiratory systems. (He hedges about how they got into the country, which is off-limits to most Americans; a title on-screen says that for reasons of “national security” he can’t reveal how they made the trip.)

Moore, whose bulky physique is a poor testament to preventative medicine, stays mostly off-camera, and he occasionally attempts—none too convincingly—to serve as a devil’s advocate. But, of course, Sicko is no more “objective” than his previous films, and it uses the same satirical techniques. Congressmen who’ve taken large donations from pharmaceutical interests are given on-screen price tags, pop songs amusingly comment on the action, and whenever possible, the director ties this movie to the war in Iraq, the subject of his previous movie. He ultimately blames the whole health-care mess on Nixon, who can be heard on an Oval Office tape endorsing Kaiser Permanente’s idea of HMOs—whose principal role, Moore argues, is to deny medical service. Finally, and most annoyingly, Moore turns a private good deed into a very public nyah-nyah-nyah to one of his small-time detractors.

Sicko does discuss the American system—or lack thereof—that links health insurance to employment and denies it to millions. Mostly, however, Moore compiles anecdotes. Some of the most effective ones come from refugees of hospitals and insurers, who fled their employers’ constant demands to treat health purely as a matter of profit. (A former Humana employee explains that bonuses were awarded to doctors with the highest refusal rates.) A chilling surveillance video shows an impoverished patient being dumped at a Los Angeles homeless shelter, dispatched by cab from a hospital that refused to care for her. There are also stories of people who were forced into bankruptcy, lost parts of their bodies, or watched loved ones die needlessly, all things that just shouldn’t happen in a country as wealthy as this one.

The problem with anecdotes, though, is that anyone can collect and deploy them. A right-wing filmmaker could make a counterattack that musters “socialized medicine” horror stories from France, Canada, and Britain. (Several fiction films have already had some fun at the expense of the latter two nations’ medical systems.) As for Cuba, that’s another of the movie’s nyah-nyah-nyahs. However sentimental the American left is about Castro’s fiefdom, and regardless of how absurdly punitive U.S. policies toward the country are, bringing desperate Americans to Havana for medical care proves nothing. This was primarily a propaganda opportunity for the Cuban doctors, who naturally did their best for their celebrity guests. That doesn’t mean they would, or could, do the same for their own citizens. (By the way, at least some of the 9/11 workers with shredded lungs got this affliction because they refused to wear respirators, but you’ll have to listen carefully to hear any acknowledgment of that in Sicko.)

That the movie travels to Cuba is altogether typical of Moore’s perversity, which also explains why a song by Islamic zealot Yusef Islam (aka Cat Stevens) appears on the soundtrack. The director would rather scourge than persuade. Baseball cap and flannel shirt aside, his “populist” persona is a sham. Moore is an elitist who refuses to search for common ground with his adversaries—not that you can really blame him, since his adversaries are the likes of Nixon, Bush II, and congressman tuned pharmaceutical lobbyist Billy Tauzin. Fortunately for Sicko, retired British Labor Party leader Tony Benn agreed to appear. He eloquently presents the case for social democracy that Moore—too busy running off to kick his enemies in the shins—can’t focus long enough to make.