(MONEY Magazine) – In the rancorous debate over health-care reform, the American Medical Association -- representing almost half of the nation's 653,000 doctors -- has opposed President Clinton's plan, which would require employers to pick up most of the nation's health insurance bills. Their stated reason: It limits consumers' health-care choices. But here's another likely reason: Roughly 34% of all doctors are themselves employers -- of nurses and clerical staff -- and it turns out that M.D.s are notoriously stingy about providing insurance for their own workers. "There's a real conflict between the doctor as caregiver and the doctor as small businessman," says Sara Nichols, a Washington, D.C.-based attorney for Public Citizen, a consumer advocacy organization. According to an exclusive study done for MONEY by the Harvard Medical School Center for National Health Program Studies, a health policy research organization, 49% of workers employed by doctors with their own practices are not offered health insurance. That leaves the employees to seek coverage through a spouse or to buy it on their own at average costs of $2,000 to $4,000 a year and up. The steep price tag places health insurance beyond the reach of many employees, including Evelyn Guarnaccio (at left), 38, who is single and earns just $15,600 a year as a receptionist for a successful Jersey City ophthalmologist. Says Guarnaccio: "God forbid, what if I get sick and get stuck with bills I can't afford?" Her employer, Dr. Bhupendra Vora, says: "At present, I'm not providing coverage because that's the way it is. If I'm forced to, I will." * The health-care industry in general, hospitals and nursing homes included, is not much of a health insurance provider. According to the Harvard report, about 35% of the nation's 10 million health workers are not offered health- care insurance by their employers, vs. 25% of all private-industry workers and 7% of public employees. Self-employed doctors, echoing many other small-business owners, "often say they can't offer health coverage and still make a profit," says Dr. Steffie Woolhandler, author of the Harvard study. The AMA says insurers are partly to blame. Some carriers charge doctors as much as 25% more than the price for other small companies, says an AMA spokesman. "Doctors and their staff tend to file more insurance claims than the average employee because they know how to work the insurance system better," says Harvie Raymond, spokesman for the Health Insurance Association of America. The Employee Benefit Research Institute says that, overall, only 46% of workers at private firms with fewer than 25 employees get insurance. So by insuring 51% of their employees, doctors are actually doing slightly better than the average small business. But medical practices are generally more lucrative. The average solo practice -- one doctor and two employees -- grosses about $317,000 a year, according to the AMA, compared with an average gross of only $243,000 for a nonmedical business that size. And doctors do much better than the average small business when it comes to providing insurance for themselves. According to the Harvard report, 86% of office-based physicians are covered through their practices. Only 45% of small-business owners in general have coverage, says the National Federation of Independent Business. Furthermore, a 1993 survey of 2,224 doctors found that 96% offered free or cut-rate care to other doctors and their families; just 53% of those surveyed said they would give all nurses similar courtesies.

The Harvard report estimates it would cost the health-care industry $2 billion or more annually to cover employees under the Clinton plan. Doctors -- along with all other employers -- would have to pay 80% of the cost of health premiums for their workers, as much as a maximum of 7.9% of payroll. Although Clinton would provide government subsidies to financially pressed small businesses that could not afford premiums, the AMA says that roughly 90% of medical practices would be ineligible because of their high earnings.