Irreverent and often sophomoric, Michael Moore’s documentaries are like a Mad Magazine for grown-ups, dedicated to revealing the delusions and hypocrisies under which we live. His latest, Sicko, takes on his biggest target yet. And if you weren’t scared about the state of health care in this country at first, you will be by the end of this latest foray into activist cinema.

In this at-times rousing, sickening and funny citizen documentary, Moore reveals a Kafkaesque insurance bureaucracy whose entire mission is maximizing profits by purging the sick from its ranks. The figures Moore cites are staggering: There are 50 million uninsured Americans, and 18,000 die every year because of a lack of health insurance.

Despite a new spirit of compassion and soft-pedaled shtick, Sicko does traffic in some of the usual Moore-ian techniques. There is tongue-in-cheek, 1950s footage of a kinder, gentler America to contrast with our own, more jaded age. (Documentarians should declare a moratorium on this cheap and facile tactic.)

Then there is Moore’s self-conscious, honey-dripping voice-over narration; the manipulative use of music; and finger pointing at villainous bigwigs such as Richard Nixon, whose policies, Moore argues, helped set the stage for the out-of-control health care industry.

And yet despite some of the familiar conventions, this time around Moore has struck gold, milking comedy from American gullibility. His juxtaposition of vintage Soviet film and American “Red Scare” footage (centered on the demonization of universal health care as “commie” stuff) is alternately hilarious and sickening.

Moore builds his case with nauseating images of an uninsured man stitching closed his own gaping knee wound, and an insured middle-aged couple so devastated by medical bills they move in with their adult children. He also exposes the trend of hospitals dumping elderly, disoriented and uninsured patients on the streets in their hospital gowns.

The power of the topic—and, by extension, Moore’s film—is its universality. Most Americans—doctors or patients, Republicans or Democrats—have had front-row evidence of how outrageously expensive and grossly bureaucratic our health care system has become.

A blue-collar jester ambling comically toward his targets, Moore often made his points by pushing his bulky body into the path of big business and videotaping the hilarious David-meets-Goliath results. This time he takes a welcome backseat and allows others to speak to the issue.

Part of the power of Sicko is avoiding easy or singular scapegoating; as one former insurance company employee points out, the health care system is far more labyrinthine than that.

By way of example, Moore travels to France and Canada, where government health care is a privilege of citizenship. Through Canadian eyes, it is America that looks like the Third World country. It’s a place whose health care is so primitive that Canadians buy health insurance before traveling here for fear they will break something on a golf vacation and be handed an astronomical bill by a Yankee doctor.

One field trip in particular dramatically illustrates his point about how easily we allow fear—of commies or debt—to dictate our behavior. Loading up a boat with sick Sept. 11 workers denied treatment in their own country, Moore takes them to Cuba for medical care in a typically showboat move. In one sweeping gesture, Moore illustrates the epic failure of the market approach to medicine, a kind of desperate and cruel every-man-for-himself strategy.

Cuba, of course, had something to gain from putting its best face forward for the visitors. But it is hard to argue with the weeping rescue workers happy to have someone even feigning interest in their plight.

Moore’s primary target is health care, but his larger target is the culture of fear under which most Americans live: fear of financially devastating illness, fear of losing our jobs, fear of paying for our own retirements and our children’s college education. Moore makes his appeal a far broader one than the insurance companies raking in enormous profits or the politicians acting out the agendas of powerful pharmaceutical lobbies. He aims his film at all of us, a citizenry that has been asleep at the wheel as its government and business have chipped away at the democratic values and sense of solidarity that make something such as universal health care such a no-brainer.

SICKO  * * * *

Directed by Michael Moore. • Starring Michael Moore. • PG-13, 113 min. • At Maya Cinemas, Osio Cinemas.