By COLIN COVERT

Star Tribune (Minneapolis)

Rick, an uninsured woodworker, lost two fingers in an accident. When the hospital laid out the costs of reattaching them, he could afford to save only one. A true romantic, he chose to keep his ring finger. But he was better off than the indigent patients several Los Angeles hospitals dump on the sidewalk beside the city's Skid Row free clinic.

Maybe things are better for the majority who have health insurance? Not always. Dr. Linda Peeno, a former medical reviewer for the health insurer Humana, told Congress how she furthered her career by protecting the firm's profits, knowingly denying a customer a life-saving operation. In effect, she helped Humana kill him - - legally, mind you - - for half a million dollars.

Welcome to health care in the richest nation on earth, where stepping on a rusty nail could be a catastrophe that plunges you thousands of dollars into debt. It's the subject of Michael Moore's most accomplished film yet.

"Sicko" is a compelling, funny, highly persuasive and ultimately hopeful report on the ills plaguing America's private, for-profit health-care system. The film skillfully blends moving individual stories, humor, political analysis and ethical passion. It doesn't simply make the problems visible. It shows that solutions are possible.

As the film notes, doctors who discourage treatment are rewarded, customers who seek care face burdensome approval procedures and legislators who advance the insurers' agenda are rewarded with lavish campaign contributions and highly paid private sector jobs. The result is a system ranked 37th in health care around the world, just slightly ahead of Slovenia's.

Moore traces the current state of affairs to the passage of the HMO Act in 1973, which ushered in the era of managed care. He effectively illustrates his history lesson with 1971 Oval Office audiotapes of Richard Nixon and presidential aide John Ehrlichman. The advisor was briefing the president on a visit by the head of Kaiser Permanente, one of the first big HMOs, lobbying for legal changes that would help such firms expand.

Ehrlichman: "All the incentives are toward less medical care, because the less care they give them, the more money they make."

Nixon: "Fine."

Moore follows the audio exchange with video of a TV address the following day in which Nixon promised legislative initiatives to give Americans "the finest health care in the world."

But Moore isn't merely engaged in partisan finger-pointing. He lambastes Hillary Clinton, once a champion of health-care reform, for becoming the second-highest recipient of donations from the health-care lobby. The cries of divisive demagoguery that have accompanied Moore's earlier films are unlikely to be raised against this one.

"Moore is right that the U.S. health care sector is bloated and inefficient, and that insurers and providers routinely rip off consumers," says conservative scholar Michael Cannon, director of health policy studies for the Cato Institute and former health policy analyst for the U.S. Senate's Republican Policy Committee.

"Michael Moore's style aside, it's hard to argue the facts," commented the American Society of Registered Nurses, which independently verified "Sicko's" charge that America spends far more per capita or health care than any other nation, but ranks low on life expectancy, infant mortality and access to physicians.

It doesn't have to be this way, Moore argues. In visits to Canada, England and France, he finds well-functioning healthcare systems operating without the fabled waiting lines, ruinous taxes or oppressive regulation we're cautioned about. We meet a French doctor who makes house calls on weekend nights, Canadian conservative party member who lauds the architect of his country's universal health care system as Canada's greatest hero, and new parents in London who laugh at the idea that Americans are charged to have babies.

Moore doesn't make overreaching claims for other countries' systems, merely suggesting that we take the best ideas they have developed and add good ones of our own. Doctors who appreciate the profit motive might enjoy the English system's practice of giving bonuses to the caregivers whose patients show the best results.

"Sicko" is Moore's most satisfying and mature film, with few cheap shots and transparent publicity stunts. But as always, his film goes on 15 minutes too long with a gimmick that undercuts his own message. In "Bowling for Columbine," it was the ambush interview with Charlton Heston. This time Moore travels to Cuba seeking care for uninsured 9/11 rescue workers denied care in the United States.

The sequence seems designed as much to infuriate Moore's critics as to advance his point about our own health care mess. "Sicko" is most effective not when Moore is lecturing us, but when he exhorts us to examine our consciences and ask what kind of nation we want to be.

Star Beacon Print Edition: 6/29/2007

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