In "Sicko," his new film assailing the U.S. health care system, filmmaker Michael Moore doesn't try to be fair to health insurers and pharmaceutical companies.

That's because Moore -- the man behind anti-Bush "Fahrenheit 9/11" and pro-gun control "Bowling for Columbine" -- makes no pretense of balance. He has a point of view: Greedy pharmaceutical companies need to be much more tightly regulated. And health insurers? They shouldn't exist at all, replaced instead by government-subsidized health care.

It's safe to say the health care industry looked forward to the film's opening Friday about as much as they would to open-heart surgery.

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All the same, industry representatives tried to downplay the potential impact and insisted the film was causing them nothing more than a mild case of angina.

"Unfortunately, this is a Hollywood editorial. It is not a documentary and it should be seen as such," said Mohit Ghose, spokesman for America's Health Insurance Plans, the industry trade group. "He (Moore) made no attempt to contact us ... about the issues he raises in the movie."

Ghose said he has no plans to see the film. But many insurance insiders admit to having already seen the film in previews, clips or in a bootlegged copy that appeared briefly on the Internet almost two weeks ago.

Moore builds his case against managed care through a series of anecdotes: a woman whose health insurer denied treatment on the basis she was "too young" to have cervical cancer; another who was billed for an ambulance ride after a car accident because she failed to get the trip "pre-approved."

Some cases are heart-wrenching, such as a Kansas City man who died from kidney cancer after his insurer deemed his treatment options "experimental."

Focus on talking points

As part of its damage-control strategy, insurance industry executives talked among themselves and agreed to focus on a few "talking points." They say they encourage debate about health care reform and support initiatives to reduce the number of uninsured Americans.

Insurers decided it was not in their interest to enter a public battle of wits with Moore, whose "Fahrenheit 9/11" was the top-grossing documentary of all time.

"We all agreed that taking the high road as opposed to taking on Michael Moore is what we wanted to do," said Matthew Schiffgens, spokesman for Kaiser Permanente.

Shannon Troughton, spokeswoman for WellPoint Inc., the parent company of Blue Cross of California, said there was no "strategy on our part to handle this in any specific way."

"There's a difference between the movie, which is more of a one-sided piece of entertainment, versus what really needs to happen, which is a dialog and conversation at all levels about health reform," she said.

Kaiser's rebuttal

Still, many companies have taken it on themselves to clarify the ways they believe they've been misrepresented in the film.

Kaiser, headquartered in Oakland, posted a rebuttal on its Web site to the way it was portrayed in specific portions of the film.

The HMO features prominently in a 1993 case involving 18-month-old Mychelle Williams. The little girl died from a blood infection shortly after being transferred to a Kaiser hospital from Martin Luther King Jr. /Drew Medical Center in Los Angeles.

While the film contends she died because Kaiser refused to authorize tests that would have determined her condition, Kaiser said it was a case of medical malpractice, not denial of treatment. The jury found both doctors involved to be liable, with King/Drew responsible for 75 percent of the more than $1.35 million in damages and Kaiser for 25 percent.

Kaiser also took issue with the film's portrayal of a conversation between Richard Nixon and John Ehrlichman, in which the former president's top domestic adviser urged him to set rules authorizing the health maintenance organization structure. He cited Kaiser as an example, arguing that its model of medicine provided less care and therefore made more money.

"Ehrlichman's distorted paraphrase badly misrepresents Kaiser Permanente, its goals, its strategy and its not-for-profit model," Kaiser's Web site states.

As for a segment in which Kaiser is accused of dumping an indigent patient near a Los Angeles shelter, Kaiser admitted to handling the transfer "very badly" but called it an isolated incident. Kaiser said it has changed its practices to prevent the inappropriate discharge of homeless patients.

Blue Shield of California, based in San Francisco, said Moore did not tell the full story in the case of Maria Watanabe, a woman who explained in the film she was denied an MRI and finally received one in Japan, where she discovered she had a brain tumor. The filmmaker ends her story by saying she hired a lawyer.

"Blue Shield was completely unaware of the women's medical condition until we were sued, and we prevailed in a jury trial. The filmmaker was aware of the trial and undoubtedly knew the outcome," Blue Shield spokesman Tom Epstein said.

Blue Cross of California declined to discuss the case of a woman whose policy was retroactively canceled for failing to disclose she had a yeast infection. The company said the case was "favorably settled by both parties."

A pharmaceutical-makers' trade group fired off an early counterattack with a press statement in May accusing Moore of producing a "biased, one-sided attack." The industry, which plays a smaller role in the film than it apparently expected, has laid low in recent weeks.

Enough said

For his part, Moore has said he didn't try to hunt down industry executives as he famously did with General Motors in "Roger & Me." Industry -- pharmaceuticals in particular -- already has had more than enough say, he argued.

"The nightly news seems like every other ad is a pharmaceutical ad. Their story is told over and over again every single day. This is an attempt for two hours during the whole year -- two hours, the length of this film, to say here's the other side," he told the Seattle Times.