Written and directed by Micheal Moore

The new film from Michael Moore is exactly what one ought to expect by now - modern-day muck-raking at its best, leavened with humor and compassion. Once again, Moore has taken on an important subject that affects every American, and raised questions which need to be - but seldom are - part of the public dialogue.

Whether we agree or disagree with individual points is less important than that we talk, openly and passionately, about our situation, how it arose, whether we are happy with it, how we might change it if that is what we want, and what we might change it into.

As usual, it is easy to dissect Moore's criticism, to nit-pick and find fault - especially when that criticism is as sweeping and wide ranging as it is here. But there is little to be gained by doing so. It's not the literal exactness of individual facts that matters here, as much as the identification and recognition of a pervasive social problem.

The effectiveness of Moore's work lies in the fact that picking his nits - as some critics choose to do - merely distracts from, but can not respond to the single, clear, incontrovertible fact around which his film revolves: that our country - which we want to believe is "the greatest nation on earth" - is unwilling to do what every other industrialized country in the world does - provide good-quality, accessible health care to all of its citizens.

America is so deep in denial of this fact - advertising , public relations campaigns and even the government relentlessly try to sell the idea that America "has the best health care system in the world" - that much of Moore's film is spent testing that claim. He travels to three countries that are among our closest allies - and one we have treated as a pariah - and talks to the people there about their health care systems, as well as comparing statistics on medical outcomes, to offer an alternate perspective.

As usual. Moore's detractors make the point that his presentation is not "balanced" and that he is not "objective" about his subject. But as has become increasingly clear with each successive film, Moore does not aspire to be a "documentarian" in the old-fashioned sense of that word. In fact he has re-invented the documentary as a sort of "filmed-editorial."

Like an editorial writer in a newspaper, Moore takes a stand and makes his case concisely and generally. Like an editorial, Moore's films don't purport to be exhaustive, scholarly analyses of the issue. Rather, they present "opinion" and the general outlines of the evidence on which that opinion is based, and leave their audience free to examine the specifics and do more complete research for themselves.

I discussed Moore's general approach to his films as well as some of the objections that have been raised and the responses they have generated in my review of Bowling For Columbine, published in these pages, so I won't repeat myself at any length here.

In company with the great muckrakers of the early 20th Century - Upton Sinclair and his ilk - Moore is as much provocateur as reporter. He wants to break through the preconceptions and prejudices with which our education and popular culture have burdened us, and ask us to join him in examining those very postulates in light of apparently contradictory evidence. He want to provoke his audience to think and to act.

This is a dangerous purpose. No one likes to have their fundamental assumptions questioned. It is a process that is disturbing and disorienting. Add to that the fact that very powerful interests - our health-care, insurance and drug industries and the politicians who support them - continue to proclaim with Orwellian confidence that everything is fine, and our health-care system is the envy of the world. The last thing they want is for people to take action to change what is for them a very successful and profitable system Moore starts by addressing this heavily advertised myth.

He points out that in the first place, 45 Million Americans - about 20% of the population - have no health insurance at all. He graphically illustrates this situation with a scene of one of these 45 Million suturing a gash in his own knee because he can't afford to go to an emergency room. But, Moore points out, his real subject is not the uninsured, but the system that creates such a category in the first place.

He moves on to address the very real problems faced even by those who are financially comfortable and responsible enough to have "protected" themselves with health insurance. Using a combination of personal anecdotes (when he solicited such comments on his web-site he received more than 25,000 responses in one week), statistics, and testimony from former Health-care industry insiders, Moore paints a vivid picture of a system that puts profit far ahead of client service and public welfare.

In a series of sequences that range from the tearful reminiscence of family members who lost loved ones because their insurers put protocol and financial considerations above saving lives, to the sworn testimony of a witness before a congressional panel that she felt that as a Medical Expert for an HMO, she had caused the deaths of a number of clients by finding pretexts to deny them needed services, Moore establishes the ruthless insensitivity of the corporations who dominate the system.

He wisely follows the course of the common arguments about this situation - where exposure of the deficiencies of the American system regularly elicits the assertion that this system may not be perfect, but others are worse. Moore turns aside this red herring with visits to other industrialized nations that do provide health-care to all their citizens.

Through interviews with doctors and patients as well as widely available (but often suppressed in the US) statistics he shows that the canard about theAmerican system being superior and generating greater freedom-of-choice and patient satisfaction than the "national health" systems of Canada, France, Great Britain and even Cuba is just another pubic-relations fantasy.

He mentions in passing the important fact that our federal legislators - who claim the US "can't afford" universal care - do manage to find the funding to award themselves and their families free coverage that is probably the best in the world. He contrasts the public rhetoric of our leaders about their "respect" for the "heroes" of the events of September 11, 2001 - including the rescue workers -with the treatment of those same workers within the health-care system

Perhaps most devastatingly, he shows what may be the nadir of the for-profit health-care system, where indigent patients with nowhere to go are simply dumped by hospitals in front of an inner-city rescue mission - in one case, still in hospital gown and slippers.

At the end of this powerful, fact-filled, emotionally engaging indictment of the status quo, Moore reflects on the story with the most chilling and painful question that the process evokes: "What kind of a people, what kind of a nation, are we?"

Having graphically illustrated the level of callous indifference we allow our health-care system to show to people, the treatment of our fellow human beings as so much potential "financial loss" to be "eliminated" as soon as possible and by any means available, Moore's question is a resonant one, which ought to make us all uncomfortable. And of course this is what Moore intends.

Like the eloquent, passionate reformers of the American Muckraking tradition (of which he is the best contemporary example) Moore wants to make us squirm, to make us ashamed, but most of all, to make us take action to make change.

In service of getting this message across, making it palatable and the pain it inflicts on some of those interviewed bearable, Moore engages his whole bag of film-makers tricks - something you can actually see developing from film to film. He injects stock footage with ironic voice-over narration. He creates montages that make visual puns, combine disparate elements to illuminate contrasts, or use repetition to expose the empty hypocrisy of politicians' rhetorical tricks. He combines the cold world of statistics and analysis with the warm one of personal story-telling.

And he's getting better and better at it. The unavoidable amateurishness of Roger and Me, which became a bit of a pose in Bowling For Columbine, where he clearly had the funding and expertise to make a sophisticated work, and - though much reduced - stuck out like a sore thumb in the polished presentation of Farenheit 911, is almost entirely absent here. Moore is a subtle, thoughtful film-maker, with the resources to travel the world in pursuit of his story, and he's not ashamed to let that show - in fact, to exploit his success to make his point.

He does just that in an anecdote about one of his most bitter critics, who was being forced to shut down his anti-Moore blog by the financial burden of his wife's illness, a byproduct of the American medical system. Moore - who can afford such largesse - sent him an anonymous donation to cover the health-care costs and allow him to resume his attacks - and used the story to great ironic effect in the film!

As writer and director, Moore continues to hone his craft, as he sees it. His ability to combine and contrast the different stands of his argument here, the different stories and tones, from the humorous to the deeply moving, speaks to an evolving sense of what works and doesn't work in his films - a clear indication that he is listening and responding to criticism, and learning from it.

If you live under the American health-care system, you can't watch this film with indifference - and indifference is the real villain in all of Moore's work. You may agree with Moore's conclusions or you may reject them (although he makes his case compellingly) but no matter your reaction, you will react strongly to this film - and that is at the heart of Moore's intention as a film-maker. On those terms, there is no denying that he is a unique voice in film, creating a genre and style all his own.

But that's just my opinion. What's yours? Let me know.