WASHINGTON — As a bipartisan group of former Senate leaders counseled compromise as the way to a successful remodeling of the nation’s medical system, Senate Democrats and Republicans fell into discord Wednesday at the start of the drive to write the actual legislation this summer.

The complicated first draft of the health-care bill, written by the majority Democrats, could have been the work of “Rube Golberg, Ira Magaziner and Karl Marx,” Republican Sen. Judd Gregg of New Hampshire said as the Health, Education, Labor and Pensions Committee convened the historic debate.

“This is déjà vu all over again,” said Gregg, referring to the collapse 15 years ago of President Bill Clinton’s ambitious health-care initiative — largely engineered by Magaziner, of Rhode Island.

Sen. Barbara Mikulski, a Maryland Democrat, retorted that the Republican view of medical reform is “a combination of Adam Smith, Darth Vader and The Invasion of the Body Snatchers, so I like our plan better.”

On the other side of Capitol Hill, former Senate Democratic leader Tom Daschle and Republican leaders Bob Dole and Howard Baker said the best way to get a satisfactory health-care overhaul done was through a compromise that forces all sides to sacrifice something. For example, they suggested health-benefits taxes of a sort that President Obama rejected as a candidate.

“If anybody asserts that there is a painless way” to enact the comprehensive health-care bill, “I would caution you not to believe them,” said Daschle, whom Mr. Obama had wanted to lead the fight for an overhaul of health care from a position in his Cabinet. Daschle withdrew his nomination amid controversy over his income taxes.

The health committee’s acting chairman, Democratic Sen. Christopher J. Dodd of Connecticut, started the marathon bill-drafting session facing some obstacles.

Dodd — like others on both sides of the aisle — lamented the absence of the panel’s ailing chairman, Sen. Edward M. Kennedy, the Massachusetts Democrat with long experience in medical issues and a knack for cutting deals with the Republicans.

Dodd was also thrust on the defensive by the Congressional Budget Office’s critical report on the Democratic draft of the health-care overhaul. It said the plan would leave 37 million Americans uninsured, despite a cost of at least $1 trillion over 10 years.

Echoing the White House, Dodd tried to play down that critique, noting that the Democrats have left some of the most controversial policy issues out of their draft of the bill. Therefore, he said, the CBO — the decisive arbiter of cost estimates for any legislation — has not computed a final budgetary “score” for the bill.

All the same, Republicans pounded at the defects that the CBO found. Complicating the process is the fact that another panel, the tax-writing Finance Committee, must write its own version of the medical overhaul. It will then be reconciled with the health panel’s bill before the full Senate can take it up. The House faces similar complexities.

The former Senate leaders agreed that the overhaul must be enacted this year or it may languish indefinitely. But they warned Democrats against muscling the bill to passage over unified, though weak, Republican opposition.

Dole said Democrats probably could enact a health-care overhaul without any Republican support. But “elections are coming,” Dole said, and “shared credit and shared blame” are useful to protect both parties from political recriminations, he said. Besides, he added, bipartisan compromise on the most difficult public policy issues is “just the right thing to do.”

The former Senate leaders also proposed a legal requirement — opposed just as strongly by many Republicans — that every individual carry at least a basic health- insurance policy.

By happenstance, a group of educators and students from the University of Rhode Island’s pharmacy school were in Washington for a gathering of one of the many medical industry groups with a stake in the gigantic health-care overhaul. After watching the health committee session, they expressed some hunger for compromise.

“You can’t hold up health-care reform for the perfect,” said Elaina Goldstein, a faculty member and executive director of the pharmacy school. “There is never a free lunch,” she said, referring to the partisan rift over the cost of the overhaul.Insurance costs expected to rise

•Employers who offer health insurance coverage could see a 9 percent cost increase next year, and their workers may face an even bigger hit, according to a report from consulting firm PricewaterhouseCoopers.

 Costs will rise in part because workers worried about losing their jobs are using their health care more while they still have it, the firm said. The report also said rising unemployment is driving up medical costs.

 Health care reform legislation currently being hashed out in Congress likely will have little impact on next year’s costs, said PWC principal Michael Thompson.

 The report projects the expected cost increase per person for employee benefits plans, and it factors in things such as price increases, as well as utilization changes.

 Businesses confronted with increases will likely pass some of the burden to employees via higher premiums, deductibles or copays, Thompson said. (AP)

jmulligan@belo-dc.com