"If we're going to insure all Americans, which is a worthy and appropriate cause, then somebody has to pay for it," Bertolini said of the expected premium increases under Obamacare.
Bertolini said that insurance premiums could double in some places just on the basis of what types of policies people buy today.
He also said that when Obamacare is fully implemented, it won't start the way people had hoped and it won't be cheaper.
Over the longer run, the key to bringing down premiums will be controlling health care costs, he added. "It'll be fits and starts, but we'll get there," Bertolini said.
Higher premiums also will not necessarily mean higher margins for Aetna. "The people coming into the system will be sicker because they have not used services," Bertolini said. "So in the initial part of this program it will cost more to take care of people because they have been going without health care for so long."
The Aetna executive also weighed in on the debate over the country's fiscal situation.
(Read More: Forget the 'Fiscal Cliff,' Look at These Cliffs)
Bertolini said a big deal would be the best deal for the country, but that it's looking increasingly unlikely that politicians do anything more than a short-term fix which won't be enough to restore confidence.
And confidence is key to increasing business investment and spurring economic growth. "A grand bargain won't create a slow economy," Bertolini said. "It will restore confidence and we'll all invest."
He added, "Americans don't want Plan B, they don't want a short term fix. They want the very best we can come up with. They want Plan A."