Although reform is needed to fix the uninsured crisis, it requires a joint effort of government and the private sector and should preserve the nation's employer-based health insurance system, Aetna Chief Executive Ronald A. Williams told a congressional panel. Changes in the $2.2 trillion U.S. healthcare system to help the 47 million uninsured must deal with the interrelated issues of cost, quality and access to care, he added. More than three years ago, Aetna became the first national insurer to publicly endorse a requirement that all people have at least basic health insurance. Williams described other points in Aetna's plan for reform during testimony given to the Senate Committee on Finance.