The last thing I want to see when I go to the movies is a propaganda piece. So I approached John Q, Nick Cassavetes' new healthcare thriller, with some trepidation. The previews and press releases made it clear, in no uncertain terms, that the movie had a point to make--namely, HMO = BAD, UNIVERSAL HEALTHCARE = GOOD. I share this sentiment mostly, but I don't need to spend $10 to see it confirmed.

So I was pleasantly surprised to find, at the heart of an otherwise straightforward piece of propaganda, a strong performance by Denzel Washington in the role of the title character, John Quincy Archibald. With the help of a few extra pounds, some choice T-shirts ("M&B Racing Transmission, " "Metalworks Incorporated"), and a bland but effective series of set-up scenes in the movie's first twenty minutes, he does a fair impression of a working-class man trying to make ends meet. Where he really shines, though, is toward the end of the movie, when his ability to turn instantly from confidence to insecurity, anger to despair, and then back, helps lift the film above its melodramatic premise.

When John Q's son is diagnosed with a fatal heart condition, for which nothing but a $250,000 heart transplant will do (an amount his limited family health insurance policy certainly cannot cover), John follows his wife's advice to "do something": He takes a hospital emergency room hostage and demands his son's heart transplant as ransom. What follows is a mixture of no-holds-barred propaganda (rants about HMOs by disillusioned doctors; cheering crowds of John Q's supporters) and an effective character portrait of a man driven to desperation.

Unfortunately most of the film's supporting actors can't equal Washington's intensity. Washington manages to ignite the stereotyped role he is given into something more serious and more earnest, angrier and more touching. But the other actors seem to be trapped in one-note performances: Kimberly Elise as John Q's loving but overworked wife; Robert Duvall as a gruff but kind-hearted police negotiator; Ray Liotta as a belligerent police chief who loves the limelight; Anne Heche as the ice queen in charge of the hospital's transplant recipient list; James Woods as the heart transplant doctor who would rather hobnob with the wealthy than help a dying child. The list of clichés could go on. (Paul Johansson's smarmy TV anchor is redeemed only by his name, "Tuck Lampley. " It's a bit of delightful cartoonishness in an otherwise unplayful film).

Structurally the movie has a few good moments. At the height of the action, there are a few quick changes in pacing that do wonders for keeping tension high, and there's a nice and not entirely predictable link between the movie's opening shot and a crucial plot development near the end. It's no Crying Game, but it keeps the action moving.

But the essence of the movie is the way it deals with race, sex, class, and, of course, health care. Cassavetes quite effectively keeps the focus on John Q, his wife, and their son--that's the emotional core of the story, the part that makes it a feature film, not a political ad. He uses them to get to the movie's central message: that health care is a right, not a privilege. Along the way he brings in a series of identity issues that help hammer home the point that no matter who you are, health comes first. One side story involves a battered woman who at first lies to protect her macho, abusive boyfriend (Mitch, played by Shawn Hatosy), then finally stands up to him. Another involves racial tension in the hostage room, in which the same abusive (and white) boyfriend persists in calling the black men in the room either 'brotherman' or 'the black guy,' depending on whether he is speaking in the second or third person. Eventually, a conflict erupts between Mitch and John Q, one that is as much about race and resentment as it is about hostage-taking. The resulting picture is of a multiracial lower-middle class with a number of tensions--sex and race primary among them--but none of which are strong enough to weaken their united support for affordable health care.

One moment perhaps captures best the film's message. John Q stands facing the police cordon and crowds of spectators, a hostage in front of him, and delivers an angry, desperate tirade about his son's need for a heart transplant. Gun in hand, he lays down the causal chain: "Sick--help! Sick--help! " Translation: Society has an obligation to tend to its sick--regardless of the cost of the procedure, the age, race, or sex of the recipient, the number of other sick people who may be waiting in line for the same treatment, or pretty much anything else. Of course, this movie probably doesn't need much translation. Its messages are clear enough.

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When propaganda tries to have a heart

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