In-your-face filmmaker Michael Moore hits the jugular of the feeble American health-care system with Sicko.

SEATTLE–Michael Moore is worried about the United States. Unlike most people's,though, his worries are magnified on-screen and displayed before millions of people. Sure, he was hacking away at inequities south of the border for years in various journalistic formats (at Mother Jones magazine and elsewhere) before he hit on a cinematic approach. First there was 1989's Roger & Me , and then came his better-known efforts, Bowling for Columbine and Fahrenheit 9/11 , which together have made him a kind of anticelebrity celebrity.

Now he's back with another feature, Sicko , and this time he has fixed on a subject that touches every American in his audience, and more: health care. Or–to look at it from the point of view of the film and the millions of people paying high insurance premiums for less-than-first-rate attention–the utter lack of health care in the United States. Moore acknowledges that his open pitch for a single-payer health-care system and universal access to health coverage isn't the grabbiest topic.

"Yeah, the subject isn't sexy," he admits almost immediately after sitting down to chat about the documentary, which opens in Vancouver on Friday (June 29). The filmmaker, a big man in a gigantic blue work shirt but without his trademark baseball cap, is in a small meeting room of a downtown Seattle hotel.

"That made this the most challenging film to make, and to sell. I mean, who is going to say to their spouse or sweetheart on a Friday night, 'Hey, honey, let's go see that new health-care documentary? I hear they have liver cancer in it. Maybe pancreatic, too!' But I like that challenge, because I believe you can make anything interesting, as a filmmaker.

"Here, I start with a premise that most Americans already know: that the system is broken. So I let people tell their own stories and then go on to do something I haven't done in any of my other films: propose a solution."

These days, you could call him an optimist in a bad mood. He thinks it will make a difference. Maybe. Of course, Moore had hoped that Fahrenheit 's hot reception would prompt a similar outcry, preferably leading to the end of America's most destructive presidency.

"And it did," he states, arms firmly folded. "Bush has got like a 28-percent approval rating. More than 70 percent of the country is against the war. We're a nation of slow learners. They weren't going to, four months after the movie, remove him from office. It was always going to take a while. But somebody had to stick his neck out at the beginning and say, 'This is wrong!'

"I did it. The Dixie Chicks did it. And a few other people said something. And we were vilified. I was booed off the Oscar stage. But I was convinced that eventually my fellow Americans would come around. Now they've seen that it's the wrong thing, they no longer support him, and we'll see what the next move is."

The next major move, naturally, is the 2008 presidential election, and Moore is sanguine about the possibilities. As Sicko makes clear, the big-money medical establishment eventually reached Hillary Clinton, despite the fact that she started her husband's first term as the number one proponent of universal health care in America.

"You're talking about the next president of the United States," he says with casual certainty. I think she still knows what's right, morally. We just don't know if she still has the courage to act on it."

Apparently, producer Harvey Weinstein pushed the director to remove the Hillary material but Moore prevailed. In any case, he saves his opprobrium for the opposition.

"The Republicans, with every move they make these days, look like they are trying to prepare themselves for a place in the American Museum of Natural History. They are going to go extinct if they don't wake up. You had an election in Canada, some years back, in which virtually every Tory was removed from office. The party literally had to be replaced. That can happen. Let me put it another way: I am now in the mainstream majority."

Moore, from the blue-collar rust belt of America and a lifetime member of the National Rifle Association, sees himself as back in the centre of U.S. thought.

"I've always felt that I was very much in the majority of political opinion. You know, the American people are generally a lot more liberal than they are given credit for. They just don't like that term. If you go down the list of issues, most Americans are fairly progressive–with the exception for the death penalty. Essentially, I think that's why my work has succeeded and why my fan base has only grown. And the more liberal I've become over the years, the larger the fan base has become, so that must mean something."

Indeed, each of Moore's films has done something like five times the business of the previous one–setting record numbers for documentaries of any stripe. Whether or not Sicko can generate that sort of healthy enthusiasm remains to be seen. After all, public opinion is a very fluid entity.

"One week, everyone's lined up to see Jesus come into Jerusalem and giving Him a big, rock-star welcome. Five days later, they're all shouting, 'Crucify Him!' and 'Give us Barabbas!'"

Moore is known for turning conflict into good marketing. Currently, he's battling the U.S. State Department over a key part of the movie, which shows him approaching Cuban waters in small boats carrying suffering 9/11 workers.

"No one believes we got there in those boats. By that I mean, they shouldn't believe it. I'm dinking around there, using satire to make a point. I'm not going to say how we got there. Now I'm embroiled in this whole situation with the Bush administration, so I really can't talk about it. But everything I just told you is true. We did have to negotiate permission to take that one boat to the demarcation line between Cuban and U.S. waters. If the Americans took a shot, and there was an incident–well, they just didn't want an incident. They did not want to provoke the Americans right there at Guantanamo. They thought, 'Here's the guy that Bush hates the most,' and that made them nervous about upsetting anyone."

Aside from the poetic licence every filmmaker must carry in order to entertain, Moore insists on his journalistic scrupulousness.

"There's no fudging going on in my movies. With Roger & Me , I basically upended the documentary format. I didn't realize it at the time. I essentially created a new genre of filmmaking–although that's not what I set out to do–using satire, having a point of view, and combining it with nonfiction journalism. But in any case, the facts in my movies are 100-percent true. I offered a $10,000 reward to anyone who could find something wrong in Fahrenheit . And it hasn't happened. Now, the opinions in my movies are mine and could be wrong. But the facts are all straight."

As far as his social responsibility goes, Moore figures he fills the gap left by Walter Cronkite and the NBC White Papers that baby boomers grew up with.

"The mainstream media has utterly failed the public," he asserts, "and that's why they have turned to documentaries. I just came along at the right time, and that's made me famous. But I try to avoid the celebrity culture as much as I can. I am just a normal person, and I try to live a normal life, a quiet life in upper Michigan. Until I was on Bill Maher's show a couple of weeks ago, I hadn't been on television for two-and-a-half years. I don't participate in the noise machine, and, frankly, I haven't wanted to go on any of these networks that had been such cheerleaders for the war. I haven't heard any of them apologize for their behaviour."

Indeed, the filmmaker's presence is much less pronounced this time, even within the film.

"I don't show up until 45 minutes into the movie, when it's time for some comic relief. Overall, I think I'm getting better at this. I spent a lot of time with my crew talking about film and filmmaking–not about politics but about the art of storytelling. How we would construct this as artists, not political activists. And we sure didn't talk about health care."

The subject did come up when the crew went to Canada to do some cross-border medical shopping. When I point out that some right-wing press up here has attacked him for being too soft on our system, he just laughs.

"Of course everyone had a few negative things to say about your health care, but all that's just anecdotal. Because Canadians like to complain. But let's put it this way: how come no American buys travel insurance when they are heading north of the border? I know we didn't!"