Introduction
It had been a long time coming when in 2010 the Obama administration and a Democratic Congress passed by a single vote in the Senate and by legislative sleight-of-hand in the House a historic reform of US health care, the Affordable Care Act (ACA). The changes leveled the playing field in health insurance by requiring all Americans to buy and all sellers to sell to all comers, mandated that large and mid-sized employers provide insurance or pay fees for government coverage, and ended preexisting condition exclusions in health insurance policies as well as a plethora of other industry abuses that companies indulged in to protect themselves from adverse selection, moral hazard, and an inevitable death spiral if they enrolled too many sick patients. Access to care was expanded by the ACA through these market reforms, through broadened Medicaid coverage in states that chose to accept a generous offer of federal support for expansion, and through state or federal exchanges that sold comprehensive policies at reasonable premiums made affordable by subsidies based upon a sliding scale of income.
But the Republicans hated the ACA (which they dubbed Obamacare) in part because of the way the law was passed namely, by avoiding the necessity of a confirming Senate vote that would have fallen one vote short of ending a fatal filibuster. (A liberal Democratic senator had died and been replaced by a Republican after the bill left the Senate, so there was no chance of passing it there again if the House made too many changes.) But conservatives also hated the law because, in their view, it inappropriately expanded the role of the federal government into areas they believe are better
left to the private market or state governments. Thus, when the Republicans took over the House after the 2012 election, they began a series of nearly 60 votes to repeal Obamacare. The votes won a majority in each Republican House time after time, even though President Barack Obama was sure to veto the bill. But while Republicans knew they were shooting legislative blanks, they also thought that the vote might garner favor with supporters without causing much pain to some constituents. Nonetheless, when President Donald J. Trump took office in 2017, supported by Republican control of both houses, the repeal failed because three Republican senators balked. Two could not support the damage it would do to their constituents who were happy with their ACA coverage, and one was offended by the closed-door drafting of the bill that led to the repeal vote. Given the tiny majority the Republicans had in the Senate, the repeal went down in defeat, just one vote short.
Still, President Trump vowed to keep his campaign promise to repeal Obamacare, and he set about doing as much as he could with his executive authority. Thus, Congress terminated the ACA mandate that all Americans buy insurance, the president ended some subsidies that made many poor Americans able to afford insurance, and granted states authority to offer less comprehensive and shorter-term policies than called for by the ACA all of which also served his purpose of undermining public approval and confidence in the ACA. In addition, by delaying announcement of whether insurance carriers will be paid back for subsidies they are required by the law to grant to low-income people, he created uncertainty expected to drive some insurers out of the market. Other orders restricted funds and time for open enrollment and outreach enrollment assistance to eligible people, barred regional office staff from participating in open enrollment events, invited governors to request waivers of ACA requirements, allowed employers to opt out of contraception coverage if they have religious or moral objections, and directed federal agencies to find additional ways to permit sale of insurance that does not meet ACA standards.
To appreciate the full potential harm to the ACA of these efforts, it is important to understand one simple reality of insurance: For a company to avoid bankruptcy because too many sick people enroll, it must be careful that
people who are not sick also enroll. Those who enroll with a company become its “risk pool.” If the risk pool gets too sick, the company must raise its prices, with the effect that the least sick people now refuse to buy insurance, even as the sickest can’t afford to go without it. Consequently, the pool gets sicker as only those who are sick or very much fear getting sick enroll at high prices. This is called the death spiral of insurance: As rising premiums drive out first the well and then the less sick, the pool becomes sicker and sicker and premiums go higher and higher.
The ACA protected insurers against a death spiral by requiring everyone to buy comprehensive policies and by preventing insurers from setting prices based upon medical need. The changes made by President Trump and federal agencies at his direction has had the effect of eroding the strategies designed by law to guarantee that the insurance risk pools include healthy and younger people and are not dominated by sick and older people. The result has been an inevitable shrinking of the risk pool in many counties, a sicker, more expensive group of buyers willing to buy insurance, flight from those markets by insurance companies that fear that costs will exceed premiums, and requests by remaining insurers for much higher premiums. With access to insurance coverage beginning to narrow and the number of uninsured rising again from the historic lows reached following implementation of the ACA, the pool has been becoming sicker as only the sickest patients have been willing to pay the higher premiums.
If you are a supporter of health insurance for everyone, this is very bad. If you believe that the federal government had no business usurping the states’ role in health insurance regulation, then these steps that undermine the ACA and may cause it to fail in many counties means less federal overreach. These divergent views generally reflect political alignment: Most Democrats want the ACA preserved and improved; many Republicans want it to shrink, one way or the other. President Trump wants it gone. That is what he promised in his campaign.
If Democrats were to regain control of Congress, they might be able to put some fixes back in place, provided President Trump did not veto them something he would likely do unless Congress offered deals on other administration priorities.
Yet come what may with the ACA, there are still significant problems with American health care. Our costs continue to far outstrip those of comparable nations, our drug prices are far higher than those of other countries, and our care intensity varies widely from hospital to hospital, city to city, and state to state, with much of the care rendered proving ineffective and probably wasteful.
But there are hopeful signs. Some incentives for improvement were adopted in another new, less salient, law: the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). In a rare instance of both bipartisan cooperation and acceptance by the physician community, Congress passed a major reform of the way Medicare pays physicians and other providers, hoping to move their payment incentives away from volume and toward effective performance. The goal of the law is to ensure that more providers follow best practice guidelines, rendering only care of proven effectiveness for the patient’s condition, reporting diagnoses and treatments to electronic health records systems, innovating while avoiding unnecessary expense, and achieving markers of quality and cost-conscious performance. Meeting standards means earning bonuses. Departure from standards, excessive volume, high cost care, and other unreformed behaviors lead to fines. How tough the performance standards will be and how hard the fines will bite will be greatly influenced by regulations to be written by an executive agency, the Centers for Medicare and Medicaid (CMS). Critics feared that force of the law would be blunted by the Trump administration.
Such is the way of American policymaking in health care. What we pay for health care, how much we rely upon market competition versus regulation, how much we accept differences in the quality of health care, how much excessive, unneeded, and potentially harmful care we tolerate and pay for, and how some of us run into financial and other access barriers when we try to get care are all aspects of health policy and are shaped by many forces. These include the president, Congress, federal agencies, physicians, drug companies, unions, hospitals, medical equipment makers, insurance companies, managed care organizations, patient advocates and other interest groups, state legislatures and state bureaucracies, and all of us consumers of health care who demand that we have access to all the care that is available,
whether we need it or not. Republicans tend to favor market solutions and fear bureaucratic interference in medical decision making. They worry that an overbearing federal government will create a dependent class. Democrats criticize the market approach as unrealistic, given the many restraints on competition, and worry that it will produce barriers to insurance and care, which will create a divided society consisting of the nonpoor who are in good health and the poor who are in ill health. Policies change between administrations of different partisan persuasion, though frequently ideas from one administration are adopted by another. Republican President George W. Bush won passage of Medicare prescription drug coverage, an idea that had been pushed by his predecessor, Democrat Bill Clinton. President Obama’s ACA adopted market exchanges to sell ACA policies, an idea long favored by Republicans. Or did Republican Senator Marco Rubio (FL), who pushed the state legislature to fund a small health exchange in his home state when he was leader in the of Florida’s House of Representatives, get his idea from the Republican-derided “health alliances” offered in President Bill Clinton’s failed 1994 health insurance plan?
US health care policy reflects the complex cultural, political, economic, social, historical, and institutional forces that shape it. This book explores how government makes health policy, including the partisan political forces that influence decisions. Most health care in the United States is delivered by the private sector, but because public policy pays for and regulates so much of this care, health policy is vitally important. Moreover, private payers for health care tend to mimic the payment approaches of public policy, so public policy’s reach extends even farther into the private portion of health care policy another reason that foes of large government oppose the potential distortions that they fear will result from government insurance. Because so much of health care is outsourced and becomes the income stream of privatesector providers, claims processors, makers of health care products, and others, private interest groups have a huge stake in public policy and find it a good bargain to spend rather lavishly on lobbying and other strategies aimed at influencing public health care policy.
Most industrialized countries pay for most of their citizens’ health care publicly. We place more faith in private payment and attendant market
competition to reduce prices and improve access and quality. In general, it has not worked, in part because our delivery system restricts competition in a number of ways: Some providers or insurers dominate their markets, many drugs enjoy patent protection, which they are then able to extend through a variety of means, consumers are not well equipped to act as informed buyers, and interest-group lobbies resist cost and price disclosure, disclosure of performance data, and regulatory efforts.
Our federal system continues to require a partnership between the federal and state governments in health care provision and reform. Often this leads to new ideas bubbling up from the states to the federal realm. Yet, partisanship can sometimes be a barrier to cooperation. When it came time to implement major reform programs such as the ACA-mandated expansion of Medicaid in every state, 27 of them sued the federal government and received a favorable ruling from the US Supreme Court saying the states could not be forced to expand their programs. So many Republican states did not expand. And many accepted President Trump’s invitation to impose more restrictive qualifications upon those seeking Medicaid, including requirements that they be employed or looking for work, earn incomes lower than the maximums set for eligibility by the ACA, be tested for drug use, pay higher deductibles for emergency care, and limit time participating in the program. Creative state officials are likely to come up with additional ideas for CMS to consider, and President Trump has made it clear that he wants CMS to do what it can to approve state requests, including those that may threaten the viability of the ACA.
This book examines the US experience with governing health. It is a political science book about health care policy written by political scientists, who, as former journalists, respect the role of the news as a first draft of history. Accordingly, we combine political science theory with a heavy reliance upon timely news reports of the continuing saga of health care policy. A theme of the book concerns health policy as the product of the US government’s unique ways of combining several forces:
the increasing, and increasingly pervasive, power of ideological polarization and party politics;
the need for members of Congress to constantly seek reelection, claim credit, trade votes, and overcome uncertainty in their policy choices; the waxing and waning persuasive power of the presidency, promising much, sometimes delivering, but often disappointing; the discretion exercised by the bureaucracy in its role as agent of the president, Congress, the courts, its clients, and the public; the pervasive and well-financed influence of the burgeoning army of special health interests, the coalitions they form, the millions they spend, and the strategies they employ to frame issues and shape health policy to their liking; the growing tests of strength between traditional health policy interests and ideologically motivated campaign donors; the continuing struggle of the states, torn between being supplicants, seeking more financial support from the federal government, and being sovereigns, desperate to control their own health policy destinies while trying to hew to partisan persuasions; and the challenge of effective problem definition, the choice of solutions, and various models of the policy process, all incomplete but each capturing an aspect of the insights we need if we are ever to predict policy outcomes.
The first edition of Governing Health grew out of a frustration with the absence of a text written by political scientists for use in health politics classes. Sociologists and economists have authored or contributed to a small number of worthy volumes bringing their own disciplines’ perspectives to the topic of health politics and policy, and although they have much to offer, a gap remains. Politics is more than the sociology of institutions or the workings of economic self-interest. Politics is about power, and the making of health policy is nothing if not the wielding of power. Institutional rules endow some actors with more power than others, differential endowments of other types give some interests more power than others, and the fleeting saliency of the issues themselves sometimes gives one side more bargaining power than another. This book illuminates how institutions and the policymaking process wield power over health policy.
The intended audience is students of health policy who need to understand that problems as well as solutions are political and must be treated as part of the policy process; health policy analysts who want to become more adept at gauging the political feasibility of their proposals; health professionals who seek a better understanding of how policy is made and how they might change it; health system managers who are savvy enough to see that in a system in which nearly half the money and most of the paperwork burden come from government, they need to understand how government makes its policies; and political scientists who seek illustrations of how the principles of government work in a policy arena with all the ingredients of political conflict: saliency, huge financial stakes, powerful interests, and venues in all the institutions of government. We present a comprehensive synthesis of political science research on the institutions of government and the policy process, as well as an extensive review of the policies that have governed health care for more than a generation. We try hard to keep the book as interesting as the health care policy debate really is by illustrating political science concepts with contemporary examples of changing policies, partisan fights, implacable ideologies, congressional posturing and one-upsmanship, indefatigable policy entrepreneurs and pleading patient advocates, correcting and corrupting interest-group influence, compliant and defiant bureaucrats and state actors, upbraiding court decisions, and presidents whose popularity enhances or hobbles their ability to lead this army of passion and plunder.
We begin each chapter with a comparison that shows how different the institution under study looked during various periods when new presidential administrations began their policymaking quests, each one ushering in a new era of public health policy.
President Lyndon Johnson in 1965 rode the crest of a Democratic wave of power and ideas and a growing consensus that elderly and poor Americans, at least, deserved a health care subsidy. But he stretched the compromise by eliminating means testing from his Medicare proposal and set the stage for waste and excess use of care with his payment methods.
President Ronald Reagan in 1981, elected with a mandate to shrink and
constrain government-supported health care, welfare, and social services, oversaw the passage of a major Medicare expansion program to cover catastrophic events and costs.
President Barack Obama in 2009 took health care policy by the horns, shepherded a legislative victory that made major expansions of coverage, major reforms of the insurance industry, and some modest inroads toward cost control and quality improvement, but even with a Democratic Congress was unable to produce the comprehensive, costsaving health care reform he promised in his campaign.
President Donald Trump promised repeal of the Obama plan and was strongly supported by a Republican Congress committed to doing so, but then failed in a narrow showdown with senators of his own party. He went on to demonstrate that the presidency has considerable power to do many things that may lead to the failure of Obamacare in many of the nation’s health care markets, acting through tweets, executive orders, regulatory relaxation, and directives to executive agency leadership and staff, as well as taking advantage of the president’s unique ability to frame issues and sway public opinion.
Chapter 1, “The Policy Process,” introduces health care policymaking and illustrates how it touches our lives. We start by comparing the plights of two sisters who live in Florida and experience health policy in different ways in order to show that policy really does affect patient access, care, and financial burden. We provide an overview of the ACA and President Trump’s changes to some of its key provisions, as well as a summary of some of the major health policy initiatives that have brought us to our present system. We note the influence of other policies, including the Emergency Medical Treatment and Active Labor Act (EMTALA), on access to care and on workman’s compensation and thereby illustrate that health policy comes from many quarters and takes many shapes. We contrast public and private policy. We describe the essential role of problem definition in policy formation and identify some of the sources of demand for policy change. We review models of public policymaking, including the Garbage Can model, advocacy coalitions, and institutional analysis development, among others. We review
categories of public policy including procedural, regulatory, morality, economic, comprehensive, incremental, and others in a discussion replete with examples. We consider the importance of issue framing and causal attribution in policy analysis, again with examples. We discuss solution options and the necessity of considering market versus public options and criteria and looking at the elements of market failure most relevant to the health care market. We note the importance of ideology in evaluating market failure and the historical, institutional, and partisan preference for marketbased solutions wherever possible. We discuss equity, technical feasibility, administrative burden, and political feasibility as evaluation criteria for solution options and review the criticisms of the ACA, which contrast fairness with functionality and argue that subsidizing the premiums of sicker populations with higher premiums on those who are young and healthy will drive the latter out of the market, undercutting viability.
We note that legislators vote only on policies not on outcomes, why this is so, and how this practice explains the ambiguity of some public policy. We explore how policies occasionally have unintended consequences and may at times even worsen the lives of those whom they were intended to make better.
We review patient coverage options in such programs as Medicare and their implications for treatment sources and co-payment requirements, along with the gaps in Medicare coverage and the options for filling them. We identify proposals for major revisions of such programs as Medicare and Medicaid.
We discuss the role of research in policymaking and where data come from. We describe procedures of the Centers for Disease Control and Prevention (CDC) for compiling basic health information such as birth and death certificates, tracking infectious disease outbreaks and seeking to prevent or control them, providing health education, and responding to vaccine shortages and antibiotic-resistant bacteria. We note how many of these basic public health functions differ in their implementation from state to state.
We catalogue the points of contention that have perennially plagued each major health reform proposal, including who will bear the cost burden and
what the appropriate role of government should be. We examine factors that help to explain the success of some policies and the failure of others, including saliency, timing, problem definition, institutional endowments, balkanized supporters, and others.
Finally, we describe the implementation process, the players involved, and factors that can make or break it. Each aspect is illustrated with examples from health policy options that have been considered and accepted or rejected.
Chapter 2, “Congress,” describes the structures and functioning of Congress and the motivations of its members. Its theme is that Congress was intended to be, and sometimes still is, the dominant branch of government. The chapter begins with a review of the ideas of the framers, who conferred on the legislative branch enormous powers and many binding constraints.
We describe shifts in power of party and institutional leadership and the roles and responsibilities of committees and subcommittees, which have long had special importance in health care policymaking. We also note that as partisan polarization has increased in recent years, conference committees have given way to more informal, leadership-crafted deals between the two Houses.
We devote considerable attention to the effects of party polarization on the ability of the houses to legislate, comparing partisanship in Congress and partisanship in the country and how it is manifested in the electoral process. We describe fundamental differences between the House and Senate, as well as the key role of leadership and its increasingly difficult job of holding together a majority in a party often split into factions.
We describe in detail the powerful role of committees and subcommittees in shaping health policy, focusing in particular on the House Ways and Means Committee, the Senate Finance Committee, the House Energy and Commerce Committee, and the Senate Health, Education, Labor, and Pensions Committee.
We chronicle the bill-drafting process, including debating, amending, and voting, a bill’s path from subcommittee to committee and its movement from house to house (as well as statistics showing the low likelihood of any given bill becoming a law, thanks to the many gatekeeping points in the law-
making process). We review the contentious and complementary relationships between presidents and Congress in periods of one-party dominance and the more frequent circumstance of divided government.
We detail the factors important to members considering whether or not to participate on an issue, how active to be, how to vote, and how to take cues on issues in which they are not heavily vested. We describe the congressional enterprise as well as the day to day work of a member of Congress. We explore the competition for members’ favor among interest groups, party and White House demands on them, their responsibilities and responses to constituents, and the pressures members feel to constantly raise money for reelection and produce a voting record that will help them in their quest to get reelected.
We review the models of congressional organization, why they are necessary to the body’s function, and how they manifest in rules and norms of behavior. We contrast Senate and House rule differences and their consequences, as well as the changes introduced to the filibuster.
Budgeting, the increasingly dominant task of a deficit-swelling Congress, is closely examined; we step carefully between the concepts that are likely to continue to characterize the process and the changing rules and terms that complicate it. We explain and illustrate deficits, debt, and the dire predictions that accompany their ever-steeper upward slopes. We explore the contentious reconciliation process, which can bypass the committee process and has long been a principal vehicle for modifying health policy.
We explain regular order, its frequent absence, how that happened, and why its continuing absence matters. We explain earmarks, their rise, stratospheric further rise, and eventual fall, the emergence of letter marks, phone marks, and the other incarnations of pork.
We discuss how Congress interacts with other institutions including federal agencies, states, and the judicial system.
Chapter 3, “The Presidency,” starts with the sources and scope of presidential power and the high-stakes rivalry that characterizes the relationship between the presidency and Congress even in the best of times. Focused as the book is on health care policymaking, the subject of this chapter is how the president makes choices in domestic problem solving. His
role in setting the agenda, proposing initiatives, and monitoring congressional progress is examined. A theme of the chapter is that there is much truth to the axiom that “a president proposes but Congress disposes.” The president is much more influential than any of the 535 members who work for or against him, but he is not, in the final analysis, a legislator, even though he can and does use executive orders, memos, suggestions, and uniquely with President Trump—tweets to move policy in directions he has been unable to persuade Congress to pursue. We examine the measures of presidential legislative success, both when he cannot count on a party majority in Congress and when his party controls both Houses. Even then, he must work hard to get enough members to support him in passing a law, and quickly learns to blame Congress or individual members when his proposals fail.
When the president is not of the same party as Congress, oversight hearings occur with great frequency and at times make headlines that castigate bureaucratic agency heads for inaction or actions that members of the majority party in Congress do not like. But when the president and both Houses are controlled by the same party, oversight hearings are rare, and bureaucrats find that they have fewer opportunities to resist their political leaders. Norms are violated, evidence may be ignored, and there is little recourse short of the courts’ ability to rein in policy changes that offend committed supporters of the last administration’s ideas. We review models of presidential organization, the structure of the White House, presidential capital, public support and popularity trends, agenda setting and successes, and limits upon presidential power.
In chapter 4, “Interest Groups,” we describe the zealous huckstering of that diverse congeries of hired guns, savvy professionals, and former members of Congress and their staffs, who have spun through a revolving door from government to lobbying firms and sometimes back again, niche groups, coalitions, political action committees (PACs), super PACs, and groundswell participants who engage in lobbying, campaign financing, and grassroots organizing to try to keep things off the public agenda or shape them to their liking when they cannot. We define and examine PACs and super PACs, 527 groups, bundling, and other strategies for funneling money to members of Congress. We chase the will-o-the-wisp connection between
money and votes and offer some perspectives for examining how and when interest groups get their money’s worth. We review traditional strategies of gaining access and wielding influence, ranging from grassroots movements, to direct lobbying, to in-kind service, to campaigns and more. We chronicle the growth of social media as a lobbying tool, but question whether it has thus far much changed the way things work.
A theme of the chapter is that interest groups are extremely influential— and in many instances the controlling influence in health care policymaking. Lobbyists have many resources, including detailed knowledge of policies affecting them or their clients, money, organizing skills, and singularity of purpose, and they are only too happy to show a legislator the correct path toward constituent service and comfortable reelection margins. Another theme is that while interest groups have always been one of the key institutions of government, they do not always or even usually act in the public interest.
We examine how interest groups form and stay together, the dominant role of occupational alliances, and the deliberate or inadvertent role of government itself in sometimes spawning such groups. The interest-group world of today is complex and characterized by both permanent and temporary coalitions that share and complement one another’s strengths and resources. Much of the lobbyist’s work has to do with the unglamorous job of monitoring legislation and providing information. We describe the ways in which these groups move through the many venues of government, as well as the strategies they employ in campaign giving and grassroots campaigning to ensure that they will have access after the election.
Chapter 5, “The Bureaucracy,” takes a sympathetic view of public bureaucracy. Both of us have worked for the federal government as well as groups and firms that support federal and state governments and so know well how agencies work and the enormous capabilities and resources that they enjoy. Bureaucracy here is viewed as a repository of expertise, with detail-oriented people who bring the long view to the policy process and stand ready to serve their multiple masters Congress, the president, the courts, their constituents, and the industries they regulate. We also look at the strategies bureaucrats use to increase their own discretion to pursue their
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Hennequin, P. A.
Henner, J. J.
Henry, E. L.
Herkomer, Sir H. von Herlen, Fritz
Herrera, Francisco
Hersent, Louis
Hess (family)
Heusch, Willem
Heyden, Jan van der Hildebrandt, Eduard
Hildebrandt, Theodor
Hilliard, Lawrence
Hilliard, Nicholas
Hilton, William
Hiroshige
Hitchcock, George
Hobbema, Meyndert
Hoefnagel, Joris
Hogarth, William
Hokusai
Holbein, Hans (elder)
Holbein, Hans (younger)
Holl, Frank
Hollar, Wenzel
Holroyd, Sir Charles
Homer, Winslow
Hondecoeter, M. d’
Hone, Nathaniel
Honthorst, Gerard van
Hooch, Pieter de
Hoogstraten, S. D. van
Hook, James Clarke
Hoppner, John
Horsley, J. C.
Hoskins, John
Hosmer, Harriet G.
Hotho, Heinrich G.
Houbraken, Jacobus
Houdon, J. A.
Hovenden, Thomas
Huchtenburg (family)
Humphry, Ozias
Hunt, Alfred William
Hunt, William Henry
Hunt, William Holman
Hunt, William Morris
Huntington, Daniel
Hurlstone, F. Y.
Huysmans (family)
Huysum, Jan van
Illuminated MSS.
Illustration
Impressionism
Ingham, C. C.
Ingres, J. A. D.
Inman, Henry
Inness, George
Isabey, Jean Baptiste
Israëls, Josef
Ivory
Jackson, Mason
Jameson, George
Janssen, Cornelius
Janssens, V. H.
Janssens van Nuyssen, Abraham
Jarvis, J. W.
Joanes, Vicente
Johnson, Eastman
Jordaens, Jacob
Jouvenet, Jean
Kalckreuth, Leopold von Kauffmann, Angelica
Kaulbach, Wilhelm von
Kay, John
Keene, C. S.
Keller, Albert
Kensett, J. F.
Khnopff, F. E. J. M.
Klinger, Max
Kneller, Sir Godfrey
Knight, D. R.
Knight, John Buxton
Koninck, Philip de Korin, Ogata
Krafft, Adam
Kyosai, Sho-fu
Laer, Pieter van
La Farge, John
Lafosse, Charles de Lagrenée, L. J. F.
Lahire, Laurent de Lambeaux, Jef
Lancret, Nicolas
Landon, C. P.
Landseer, Sir E. H.
Lantara, S. M.
Lanzi, Luigi
Largillière, Nicolas
Lathrop, Francis
La Tour, Quentin de
Lavery, John
Lawrence, Sir Thomas
Lawson, Cecil Gordon
Leader, B. W.
Léandre, C. L.
Lear, Edward
LeBrun, Charles
Leech, John
Legros, Alphonse
Leighton, Baron Frederick
Lejeune, Baron L. F.
Lely, Sir Peter
Lemoyne, J. B.
Le Nain
Lenbach, Franz von Leochares
Leonardo da Vinci
Leopardo, Alessandro
Leslie, C. R.
Le Sueur, Eustache
Leutze, Emanuel
Lewis, J. F.
Leys, Hendrik
Liebermann, Max
Limousin, Léonard
Line Engraving
Linnell, John
Linton, W. J.
Liotard, J. E.
Lippi
Lockwood, Wilton
Lombardo (family)
Longhi, Pietro
Lotto, Lorenzo
Low, Will Hicok
Lucas, J. Seymour
Leyden, Lucas van
Luini, Bernardino
Lysippus
Lysistratus
Mabuse, Jan
MacCulloch, Horatio
Macdonald, Lawrence
McEntee, Jervis
Maclise, Daniel
MacMonnies, F. W.
Macnee, Sir Daniel
MacNeil, Hermon A.
Madou, J. B.
Madrazo y Kunt, Don F. de
Maes, Nicolas
Makart, Hans
Mander, Carel van
Manet, Edouard
Manson, George
Mantegna, Andrea
Marcantonio
Maris, Jacob
Marochetti, Baron Carlo
Marr, Carl
Martin, Homer Dodge
Martin, John
Martini, Simone
Masaccio
Masolino da Panicale
Mason, G. H.
Matsys, Quintin
Mauve, Anton
May, Phil
Mead, Larkin G.
Meer, Jan van der
Meissonier, J. L. E.
Melanthius
Melchers, Gari
Melozzo da Forli
Melville, Arthur
Memling, Hans
Mena, Pedro de
Mengs, Anthony Raphael
Menzel, A. F. E. von Mercié, M. J. A.
Merian, Matthew
Méryon, Charles
Metcalf, W. L.
Metsu, Gabriel
Meulen, A. F. van der
Meunier, Constantin
Mezzotint
Michel, Claude
Michelangelo
Michelozzo di Bartolommeo
Micon
Mierevelt, M. J. van
Mieris (family)
Mignard, Pierre
Mignon, Abraham
Milanesi, Gaetano
Millais, Sir J. E.
Miller, William
Millet, Francis Davis
Millet (Milé), Jean François
Millet, Jean François
Miniature
Mino di Giovanni (da Fiesole)
Minor, Robert C.
Models, Artists’
Monet, Claude
Montañes, J. M.
Moore, Albert J.
Moore, Henry
Mora, José
Moran, Edward
Moran, Thomas
Moreau, Gustave
Morelli, Giovanni
Moretto, Il
Morghen, R. S.
Morland, George
Moro, Antonio
Moroni, Giambattista
Mosler, Henry
Mount, W. S.
Mowbray, H. S.
Müller, W. J.
Mulready, William
Munkacsy, Michael von
Murillo, B. E.
Murphy, John Francis
Murray, David
Muziano, Girolamo
Muzzioli, Giovanni
Myron
Nanteuil, Robert
Nasmyth, Alexander
Nast, Thomas
Nattier, J. M.
Navarrete, J. F.
Neal, D. D.
Neer, van der
Netscher, Gaspar
Neuville, Alphonse M. de Newlyn
Niehaus, C. H.
Nicholson, William
Nicias
Nicomachus
Nollekens, Joseph
Northcote, James
Oberlander, A. A.
Ochtman, Leonard
O’Donovan, W. R.
Oliver, Isaac
Oliver, Peter
Onatas
Opie, John
Orcagna
Orchardson, Sir W. Q.
Orley, Bernard von Ostade
Oudiné, E. A.
Overbeck, J. F.
Pacchia, Girolamo del, and Pacchiarotto, Jacopo
Pacheco, Francisco
Paeonius
Page, William
Painting
Pajou, Augustin
Palette
Palma, Jacopo
Palmer, E. D.
Palmer, Samuel
Palomino, de Castro y Velasco
Pamphilus
Panaenus
Panorama
Pareja, Juan de
Parmigiano
Parrhasius
Partridge, J. Bernard
Partridge, W. O.
Pasiteles
Pastel
Paton, Sir J. Noel
Paul Veronese
Pausias
Peale, C. W.
Peale, Rembrandt
Pearce, C. S.
Pennell, Joseph
Penni, Gianfrancesco
Perino del Vaga
Perkins, C. C.
Perugino, Pietro
Peruzzi, Baldassare
Petitot, Jean
Petitot, Jean Louis
Pettenkofen, A. von
Pettie, John
Pheidias
Phillip, John
Phillips, Thomas
Picknell, W. L.
Piero di Cosimo
Pigalle, J. B.
Piloty, Karl von
Pinturicchio
Pinwell, G. J.
Piranesi, G. B.
Pisano, Andrea
Pisano, Giovanni
Pisano, Niccola
Pisano, Vittore
Pissarro, Camille
Plimer, Andrew
Plimer, Nathaniel
Plumbago Drawings
Pollaiuolo (family)
Polyclitus
Polygnotus
Pontormo, Jacopo da
Poole, Paul Falconer
Pordenone, Il
Portaels, J. F.
Porter, B. C.
Portraiture
Poster
Potter, Paul
Poussin, Nicolas
Powers, Hiram
Poynter, Sir E. J.
Pradier, James
Pradilla, Francisco
Praxias and Androsthenes
Praxiteles
Predella
Preller, Friedrich
Prieur, Pierre
Prinsep, V. C.
Proctor, A. P.
Protogenes
Prout, Samuel
Prud’hon, Pierre
Puget, Pierre
Puvis de Chavannes
Pythagoras
Pyle, Howard
Raeburn, Sir Henry
Raffaellino del Garbo
Raffet, D. A. M.
Raimbach, Abraham
Ramsay, Allan
Ranger, H. W.
Raoux, Jean
Raphael Sanzio
Raven-Hill, Leonard
Rauch, C. D.
Redgrave, Richard
Regnault, Henri
Regnault, J. B.
Reid, Sir George
Reid, Robert
Reinhart, C. S.
Reinhart, J. C.
Relief
Rembrandt
Remington, Frederick
Renoir, F. A.
Repin, I. J.
Restout, Jean
Rethel, Alfred
Reynolds, Sir Joshua
Rhoecus
Ribera, Giuseppe
Ribot, Théodule
Ricard, L. G.
Ricciarelli, Daniele
Richards, W. T.
Richmond, Sir W. B.
Richter, A. L.
Rietschel, E. F. A.
Rigaud, Hyacinthe
Rimmer, William
Riviere, Briton
Robert, Hubert
Robert, L. L.
Robert-Fleury, J. N.
Roberts, David
Robinson, Theodore
Rodin, Auguste
Rogers, John
Roll, A. P.
Romney, George
Rops, Félicien
Rosa, Salvator
Rosenthal, T. E.
Rosselli, Cosimo
Rossellino, Antonio
Rossetti, D. G.
Roubiliac, L. F.
Rousseau, Jacques
Rousseau, P. E. T.
Rowlandson, Thomas
Rubens, Peter Paul
Rude, François
Runciman, Alexander
Russell, John
Ruysdael, Jacob van
Ryder, A. P.
Ryland, W. W.
Sacchi, Andrea
Saint-Gaudens, Augustus
Sambourne, E. Linley
Sandby, Paul
Sandrart, Joachim von
Sandys, Frederick
Sansovino, Andrea C. del Monte
Sansovino, Jacopo
Santerre, J. B.
Sargent, J. S.
Sarrazin, Jacques
Sartain, John
Satterlee, Walter
Sayer, James
Schadow
Schadow, J. G. and R.
Schalcken, Godfried
Scharf, Sir George
Scheemakers, Peter
Scheffer, Ary
Schetky, J. C.
Schiavonetti, Luigi
Schirmer, Friedrich W.
Schirmer, Johann W.
Schlüter, Andreas
Schnorr von Karolsfeld
Schongauer, Martin
Schreyer, Adolf
Schwanthaler, L. M.
Schwartze, Teresa
Schwind, Moritz von Scopas
Scott, David
Scott, William Bell
Sculpture
Sebastiano del Piombo
Seddon, Thomas
Segantini, Giovanni
Sequeira, D. A. de Sergel, Johan Tobias
Severn, Joseph
Shannon, C. H.
Shannon, J. J.
Sharp, William
Shee, Sir M. A.
Sherwin, J. K.
Short, F. J.
Sigalon, Xavier
Signorelli, Luca
Silanion
Simon, Abraham
Simon, Thomas
Simmons, E. E.
Simson, William
Sisley, Alfred
Slodtz, René Michel
Smart, John
Smedley, W. T.
Smillie, J. D.
Smirke, Robert
Smith, Colvin
Smith, John Raphael
Smybert, John
Snyders, Franz
Sodoma, Il
Solario, Antonio
Sorolla y Bastida, J.
Spagna, Lo
Spinello, Aretino
Stanfield, W. C.
Stannard, Joseph
Stark, James
Steen, Jan Havicksz
Steer, P. Wilson
Stevens, Alfred
Stevens, Alfred
Stewart, Julius L.
Stillman, W. J.
Stone, Frank
Stone, Marcus
Stone, Nicholas
Stoss, Veit
Stothard, C. A.
Stothard, Thomas
Strang, William
Strange, Sir Robert
Strongylion
Stuart, Gilbert
Stuck, Franz
Subleyras, Pierre
Sully, Thomas
Swan, J. M.
Taft, Lorado
Tait, A. F.
Tanner, H. O.
Tarbell, Edmund C.
Tempera
Teniers (family)
Tenniel, Sir John
Ter Borch, Gerard
Terra Cotta
Thayer, Abbott H.
Theon of Samos
Thoma, Hans
Thompson, Launt
Thomson, John
Thornhill, Sir James
Thornycroft, W. Hamo
Thorwaldsen, Bertel
Thrasymedes
Tiepolo, G. B.
Tiffany, L. C.
Timanthes
Timomachus
Timotheus
Tintoretto
Tisio, Benvenuto
Tissot, J. J. J.
Titian
Torrigiano, Pietre
Triptych
Troy, J. F. de
Troyon, Constant
Trumbull, John
Tryon, D. W.
Turner, Charles
Turner, J. M. W.
Uhde, F. K. H. Von Utamaro
Vanderlyn, John
Van der Stappen, C.
Van der Weyden, R.
Vandevelde, Adrian
Vandevelde, William
Van Dyck, Sir Anthony
Vanloo, C. A.
Vanloo, J. B.
Varley, Cornelius
Varley, John
Vasari, Giorgio
Vedder, Elihu
Veit, Philipp
Velazquez, D. R. de Silva y Verboeckhoven, E. J.
Vereshchagin, V. V.
Verlat, M. M. C.
Vernet (family)
Verrocchio, Andrea del
Vertue, George
Vien, J. M.
