This Wednesday morning, Axios Co-founder Mike Allen hosted a series of one-on-one conversations on the future of comprehensive health care across urban and rural America. Topics covered included how to get affordable and accessible care, as well as news of the day items like the rise in youth addiction to nicotine.

On Tuesday evening, Axios Cities Correspondent Kim Hart hosted a series of one-on-one conversations to discuss the future of smart cities, highlighting technology like AI and IoT.

Jeff Marootian, Director, District Department of Transportation

Director of the District Department of Transportation, Jeff Marootian, discussed how transit in Washington, D.C. has changed in the past ten years, and how the advent of ride-sharing apps has put pressure on the curbside.

• How cities are fundamentally reimagining how the curbside works: "[D.C.] recently finished a pilot program with a curbside reservation system which allows for commercial delivery drivers to reserve curbside access so they don't have to circle around a block in order to find a place to pull over, to make a delivery or to do a food pickup.
• On looking for creative solutions at the DDOT: "We have a great opportunity to reimagine our infrastructure. We know that the technology alone isn't going to get us there and the infrastructure alone isn't gonna get us there. It's really the marriage of those two things."

Hicham Abdessamad, Chief Executive, Global Social Innovation Business, Hitachi, Ltd. and Chairman of the Board, Hitachi America, Ltd.

In our View From the Top segment, Hicham Abdessamad sat down with Axios Executive Vice President Evan Ryan to discuss leveraging available data in cities to solve big problems around congestion. He highlighted the success of a recent initiative in Tequila, Mexico, which tracked the flow of people in and around the city center.

• On looking at the big picture: "It's not really about smart cities. It's about solving big problems."
• On utilizing available data to create smart cities: "We don't have the luxury to build cities from scratch all day. Countries around the world do that. So how do you retrofit or how do you leverage what's already out there to basically look at the problem and solve it in a different way?"

Kim Nelson, Executive Director, State and Local Government Solutions, Microsoft

Executive Director of State and Local Government Solutions at Microsoft, Kim Nelson, discussed the challenges for cities of all sizes to figure out what their top priorities are for leveraging technology, both in the short and long term.

• On what catalyzes change: "Sometimes it's just an event that actually grabs a city, a leader or a mayor, and says it's time for us to do something about it...Houston is a great example. In the aftermath of [Hurricane Harvey], the mayor soon realized into his term that city wasn't nearly as resilient as it needed to be. And that started the conversation. "
• On what it means to be a smart city: "Smart isn't simply about the technology. It's not about just the infrastructure, the sensors or the hardware. Being smart is about having the information."

Rep. Yvette Clarke and Rep. Susan Brooks, Congressional Caucus on Smart Cities Co-chairs

Congressional Caucus on Smart Cities Co-chairs Rep. Yvette Clarke (D-NY) and Rep. Susan Brooks (R-IN) took the stage together to discuss constituents' priorities around access, cybersecurity, and privacy as cities continue to get smarter.

Rep. Yvette Clarke

• On converting phone booths into wi-fi kiosks: "It's nowhere near what it needs to be in terms of being ubiquitous throughout the city of New York. But we know that the infrastructure and the commitment is there. And that commitment and investment has yielded dividends already."

Rep. Susan Brooks

• On preparing the workforce of the future, particularly around cybersecurity: "We have to invest in those strategies at all levels of education, whether it's the teams in schools, whether it's coding camps, whether it's certification programs. We've got to think very differently about higher education and about how we are ensuring that everybody is ready for what is coming."

Thank you Hitachi for sponsoring this event.

This Tuesday, Axios' health care business reporter Bob Herman and Co-founder Mike Allen hosted an Expert Voices Live discussion on drug pricing and demystifying the pharmaceutical supply chain.

A broken system

While the discussion proved to be a lively debate, there was one area of agreement among attendees — the current health care system and its approach to drug pricing and coverage — is broken.

• Robert DuBois, Chief Science Officer and Executive Vice President and the National Pharmaceutical Council, shared his opinion on high out of pocket costs: "Insurance is supposed to be the healthy subsidizing the sick, but with high out of pocket for drugs, it's the sick subsidizing the healthy."
• Sean Dickson, Director of Health Policy at West Health, on the system: "The complexity of the system that we built well over a decade ago is contributing to the difficulty of reforming it."

Possible fixes

Herman asked the group if they saw relatively easy fixes to the current health care bills that would allow for widespread support.

• Jennifer Bryant, Executive Vice President of Policy and Research at PhRMA, highlighted a topic of agreement among the table, "There are distorted incentives that are leading to less uptake of biosimilars and generics than we might otherwise see. One of the reasons is the incentive to put higher list-price products on formulary, and that penalizes patients the most."
• Marcie McClintic Coates, Head of Global Policy at Mylan, stressed the importance of fixing the formulary tiers, "The formulary tiers still look like 2003, we've not kept a formulary tier for any speciality generics or biosimilars, we have a one-size-fits-all bucket."
• Jack Hoadley, Researcher at Georgetown's Health Policy Institute, suggested solutions to encourage biosimilar penetration, "Some of it is just acceptance and education among the public and providers that biosimilars are a substitute, the other is figuring out — at several levels, including at the FDA — how to get biosimilars into the market."

More time, please

As the conversation came to a close, Bob Herman listed the topics he had hoped to cover with the group — the Institute for Clinical and Economic Review's reports, rebates, and an alternative system for drug pricing — if they had more time. The discussion concluded with the following key insights:

• Matt Kazan, Principal at Avalere, spoke about his time on the hill and the three things needed to get bills like H.R.3 get passed, "Members of Congress can explain the provision at home, it's bipartisan, and the Congressional Budget Office says it saves money."

• Michael Budros, Policy Director at Healthsperien, mentioned one topic left out of the conversation, "We haven't talked about how drugs and prices connect to the value to patients...It's something to think about in future iterations of price and cost reform."

Thank you, Mylan for sponsoring this event.