The chief executive of one of the country’s largest health insurance companies says he is open to having a single-payer debate.

“Single-payer, I think we should have that debate as a nation,” Aetna chief executive Mark Bertolini said Thursday.

Bertolini spoke to a private meeting where Aetna employees could ask questions of their chief executive. A partial video of his remarks provided to Vox includes Bertolini responding to a question about single-payer health care.

“In the news media, it is reporting that the Republican health plan is paving the way to a single-payer system,” an Aetna employee asks Bertolini. “What are your thoughts on that, and how would it impact Aetna?”

This was his response:

Single-payer, I think we should have that debate as a nation. But let me remind everybody that Aetna was the first financial intermediary for Medicare. We cut the first check for Medicare in 1965 to Hartford Hospital for $517.57. The government doesn’t administer anything. the first thing they’ve ever tried to administer in social programs was the ACA, and that didn’t go so well. So the industry has always been the back room for government. If the government wants to pay all the bills, and employers want to stop offering coverage, and we can be there in a public private partnership to do the work we do today with Medicare, and with Medicaid at every state level, we run the Medicaid programs for them, then let’s have that conversation. But if we want to turn it all over to the government to run, is the government really the right place to run all this stuff? And that’s the debate that needs to be had. They could finance it, and if there is one financer, and you could call that single-payer. ... We’re going to pay for it one way or another. What we have to do is we have to get the costs right. We have to get people healthy. It’s not about who is paying the bill. It’s about what we’re doing to get the costs down. The Democrats are now saying that with the new Republican bill, wait there is nothing in here about getting costs down. That’s the point. And so that’s the place we’re headed as a company. It’s not just about paying the bills.

What Bertolini seems open to is a version of single-payer where the federal government would contract out certain functions private companies, such as Aetna. These insurers would, in his own words, become a “back room for government.”

Aetna spokesperson T.J. Crawford said that Bertolini was not “advocating” for a single-payer system.

“Mark was certainly not advocating for a single-payer system, but instead encouraging debate while pointing out that public-private partnerships have been the backbone of the more successful government health care programs (examples include administering Medicare Advantage or Medicaid managed care),” he said in an emailed statement. “In other words, partnering works when done the right way.”