Watch Live: Health Policy through 2020: The ACA, Payment Reform and Global Challenges.

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When Harold Trinkunas joined CISAC in September, it was like coming home again.

Trinkunas will serve in the concomitant role of senior research scholar and associate director for research. One of the nation’s leading Latin America experts, he comes to CISAC from the Brookings Institution, where he was the Charles W. Robinson Chair and senior fellow as well as director of the Latin America Initiative in the Foreign Policy program.

“This is a great opportunity to work in collaborative ways with exceptional scholars around some very important themes in today’s world,” Trinkunas said, noting the urgency of such issues as risks posed emerging technology, the future of the global order, and international security.

CISAC co-directors Amy Zegart and David Relman wrote in their introduction of Trinkunas that his “leadership will continue to advance the center's mission of training the next generation of international security specialists; developing original policy-relevant scholarship; and extending our outreach to global policymakers to improve the peace and security of our world.”

Evolving global realities

Born and raised in Venezuela, Trinkunas earned his doctorate in political science from Stanford University in 1999 and has been a predoctoral fellow and later a visiting professor at CISAC.  His first exposure to CISAC took place when he served as a teaching assistant to Scott Sagan in 1992.

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Through the years, CISAC has evolved and adjusted its focus to reflect the global security realities, Trinkunas said. “CISAC has successfully adapted to the changing times since its inception.” Research at CISAC spans such topics, including biosecurity and global health, terrorism, cybersecurity, governance, and nuclear risk and cooperation, to name a few.

Trinkunas is looking forward to the mentoring aspect of working with predocs and postdocs while tapping into the CISAC alumni network to open doors for those rising scholars.

“The Center has developed so many positive connections to scholars, policymakers, foundations, and civil society and the private sector more broadly, both in this country and around the word. One of my goals will be to build on those relationships in a way that’s rewarding for all parties,” said Trinkunas, who also served as an associate professor and chair of the National Security Affairs Department at the Naval Postgraduate School.

Security and governance

His newest book, Aspirational Power: Brazil's Long Road to Global Influence, co-authored with David Mares of UC San Digo, was published this summer by Brookings Institution Press. 

Trinkunas is especially interested in the intersections of security and governance. In his research, he has examined civil-military relations, ungoverned spaces, terrorist financing, emerging power dynamics, and global governance.

“Latin America is the part of the world that I know most about,” he said, adding that the region particularly stands out due to the decreasing number of wars and conflicts between states over the past few decades, even as problems of criminal violence have become more salient.

Part of the reason for region-wide stability, Trinkunas explained, is that democratization led many elected leaders to de-emphasize the role of military responses to interstate disputes in an effort to reduce the importance of the armed forces in domestic politics.

In a region with a history of military dictatorship, many democratic leaders saw their own armed forces as a more significant threat to their permanence in power than their neighbors’ militaries, he said.

In addition, the U.S. foreign policy toward the region has tended to become less interventionist over time and has focused instead on minimizing the use of force as a solution to interstate disputes in the region. Recent efforts to normalize of the U.S.-Cuba relationship are a reflection of this trend, Trinkunas added.

CISAC's William J. Perry created a free, public 10-week course for people to learn more about the looming dangers of nuclear catastrophe. His new MOOC, developed with the support of Stanford’s Office of the Vice Provost for Teaching and Learning, offers a chance to take that message to a much larger audience.

Living at the Nuclear Brink: Yesterday and Today is an online course (a "MOOC") taught by former Defense Secretary William J. Perry and a team of international experts. 

“I believe that the likelihood of a nuclear catastrophe is greater today than it was during the cold war,” said Perry, who recently wrote a New York Times op-ed on why America should dismantle its ICBM missile systems.

Because the continued risk of nuclear catastrophe isn’t widely recognized, Perry believes, “our nuclear policies don’t reflect the danger. So I’ve set off on a mission to educate people on how serious the problem is. Only then can we develop the policies that are appropriate for the danger we face.” 

The course offers participants the chance to ask questions and participate in discussions via an online forum, which Perry and his fellow experts will address during weekly video chats. Each week, Perry will be joined in conversation by top thinkers, including CISAC's Martha Crenshaw, David Holloway and Siegfried Hecker, Scott D. Sagan, and Philip Taubman. George Shultz, the former secretary of state, will also participate. Outside experts include Ploughshares Fund president Joseph Cirincione, nuclear negotiator James Goodby, former Russian Deputy Minister of Defense Andre Kokoshin, and Joseph Martz of the Los Alamos National Laboratory.

Learn more about "Living at the Nuclear Brink" in this story or watch a video. Register for the course here. It is now open for enrollment and begins Oct. 4.  

Many people dread dealing with health insurance. Choosing the right plan, navigating benefits and understanding premiums, copays and deductibles can leave you frustrated and confused. Even in economic research, health insurance markets pose some of the most challenging questions.

But Maria Polyakova, a faculty fellow at the Stanford Institute of Economic Policy Research and core faculty member at Stanford Health Policy, is motivated to find the answers.

Intrigued by the shifting dynamics of the industry and inspired partly by her own experience of finding health care coverage during graduate school, Polyakova has joined a small group of health economists who are at the forefront of examining the increasing complexities surrounding the provision of medical insurance.

Changes under the Affordable Care Act have deepened the connection between public and private players, Polyakova says. There’s a rise in health care plans that are publicly funded but privately run. And many people using public plans, like Medicare, are supplementing their coverage with private add-on insurance.

The intertwined relationship raises a host of policy challenges, which Polyakova outlines in this detailed policy brief.

“We're moving toward this world where we think competition in health insurance is good because that somehow increases efficiencies and provides consumers with choices that they like,” Polyakova says. “But on the other hand, there has been a lot of debate on whether health insurance is the right place to have choice.”

Polyakova, an assistant professor of health research and policy at the School of Medicine, joined Stanford in 2014. Her ongoing economic research looks at the impact of government policies in social insurance  on consumer behavior, insurer behavior and market outcomes, including risk protection and redistribution.

By investigating the design of health insurance systems, Polyakova’s work could inform policymakers on the extent the government should facilitate competition among insurers that are providing social insurance benefits, or the steps public and private insurers can take to reduce risks and costs for consumers. Her early forays have gained recognition.

For her doctoral thesis on Medicare Part D — the prescription drug component of the federal health insurance program — Polyakova won the 2015 Ernst-Meyer Prize, which recognizes original research about risk and health insurance economics. She also received the John Heinz Dissertation Award from the National Academy of Social Insurance in 2015.

Her findings included evidence of substantial inertia among enrollees, despite significant changes in about 40 plans under Medicare Part D.

“If no one actually ever reacts to changes in products,” Polyakova says, “it could defeat the purpose of having competition.”

Polyakova continues to drill into details where answers may lie. Her empirical research in progress ranges from examining new ways of calculating risk to the effects of word choice in insurance plan descriptions.

“Policies are labeled silver, gold, platinum — theoretically to simplify the plans. But in reality, those simplifications may lead people to choose plans that are not the best for them,” she says. “Assessing the implications of their choices for the overall efficiency of the health insurance system is tricky”

The health care system appeared much more straightforward in Germany, where she worked for a year after graduating in 2008 from Yale with a bachelor’s degree in economics and mathematics.

Then while attending graduate school at the Massachusetts Institute of Technology, Polyakova went through the hassles of figuring out the health insurance system and how insurers reimburse medical providers. She recalls thinking, “Why is this so complicated?”

Polyakova turned her focus to health economics after taking some courses with MIT Professor Amy Finkelstein, a pioneer in the field who became Polyakova’s primary advisor.

“It was very contagious,” Polyakova says.