Amid heavy discussion of the problem of the uninsured and underinsured, the health insurance industry is often viewed as hard-hearted, unwilling to provide coverage to those who need it most.

Aetna CEO Ron Williams wants to be part of health reform (AP Photo/Douglas Healey)

This morning, the CEO of one of the largest insurers in the country made it clear that he sees a problem with the U.S. health system — but also envisions a continued big role for private industry.

Testifying before the Senate Committee on Finance, Aetna CEO Ronald Williams started off with some sunshine: don’t forget that more than 250 million people in the U.S. are insured! But, he added, “There are also severe and, frankly, unacceptable deficiencies within our nation’s health care system,” namely, more than 47 million without coverage.

Williams expressed support for some ideas touted on the campaign trail this year, some popular among Democrats, others more Republican. For one, he said Aetna since 2004 has supported an “individual coverage requirement” — an idea pushed by Hillary Clinton. “We believe that universal coverage requires universal participation,” Williams said, according to his written testimony. “Having the participation of all individuals is one of the most important tools, if notthe most important tool, for drastically improving the performance of insurance markets.” Namely, the healthy help pay for the sick.

When it comes to the market for individual insurance, which is especially problematic for the sick, Williams turned to an idea touted by John McCain: Tax breaks. “With both employers and employees receiving health-insurance related tax benefits, incentives are provided not only to offer insurance, but to take it up,” Williams said. “Such tax benefits are nowhere to be seen in the individual market.” Aetna believes such breaks would help more people afford coverage.

Aetna has a bunch of ideas on health reform, but the company isn’t calling for a total turnabout. “We have to build on the employer-based system, which serves so many already, to reach all Americans and not ‘throw out the baby with the bathwater’ by enacting reform that weakens the core of this system,” Williams said.