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Michael Moore is a divisive character, but he's not the most controversial man in the United States. The first image in Sicko, the director's first doc since 2004's Fahrenheit 9/11, is of George W. Bush. But the liar in chief is only one of Moore's targets this time around. In Sicko he goes after America's entire health care system, examining how even folks who have health insurance are routinely screwed over by corporations that care more about profits than lives. Of course, he does it in typical Moore fashion, with big gestures, occasionally overwrought voice-overs, and a snarky humor that balance out what's otherwise a gloomy tale.

There's so much dejection here — babies dying because hospitals won't treat them, Ground Zero volunteers being denied care, the exposure of corrupt insurance-company tactics, and worse — that comic relief is essential, Moore explained during a recent whirlwind visit to San Francisco. He'd just come from Sacramento, where the film was screened for enthusiastic members of the California Nurses Association.

"I'll bet you that there are as many laughs in this film as some of my other films, but it doesn't feel that way because there are so many sad moments," he said. "But you need that. The humor helps lead you from the despair to the justifiable anger."

Gimmicks like a Star Wars crawl to illustrate the hundreds of diseases insurance companies won't cover lighten Sicko's tone, as do scenes in which Moore puts on his gee-whiz persona and travels to other countries (Canada, England, France) where emergency treatment comes quick and free and prescription drugs practically grow on trees. In France, he discovers, the government supplies nannies to do chores for new mothers — although I'm too cynical to totally accept that perk as the truth, especially since the mother interviewed is white and middle-class. Or is it my disgust with America's shortcomings that clouds my judgment?

Disgust is what Moore is after, because it's the kind of strong emotion that might actually motivate action. "I have to hold out some kind of hope that [change] is possible," he said. "[In Sicko, an American woman living in France] says, 'The reason things work here is because the government is afraid of the people. In America the people are afraid of the government.' So I'm hoping that people will stop being so afraid and apathetic and get involved."

One of Sicko's unlikely targets is former universal-health-care advocate Hillary Clinton — now among Washington's top recipients of health-care-industry donations. In the film, the senator (and aspiring prez) is praised, then slammed, for her stance on the issue.

"I've always liked her. I had a chapter in my first book called 'My Forbidden Love for Hillary.' I always thought that she got a raw deal on the health thing that she tried to do. I could see instantly, as soon as she was in the White House, men were very threatened by her. There were whole Web sites devoted to her — hateful, hateful stuff," Moore said. "I have kind of a broken heart because of her votes on the war. And it was really sad, the discovery that she [later became] the second-largest recipient of health-care-industry money."

Moore, who said he'd lost 30 pounds in the past three months ("One way to fight the man!"), has high hopes for Sicko's long-range impact. "The whole system needs to be upended. If the American people actually listen to what I'm saying here, that we need to start rethinking everything in terms of how we treat each other and how we structure our society, a whole lot of other things are gonna get fixed, and we're gonna be a better people.