Let's stop counting on charity to pay medical bills

  1. 11
    http://www.contracostatimes.com/sear...costatimes.com

    Readers Forum: Let's stop counting on charity to pay medical bills

    By Rose Ann DeMoro
    Guest Commentary

    Updated: 01/02/2009 05:05:10 PM PST



    THE MOST heartbreaking e-mail alert that crossed my computer screen this holiday season came from a union which has set up a fund for medical benefits for widows and orphans of their former members.

    Reliance on charity rather than a public safety net symbolizes what has become a perversely unique American solution to social problems, especially in the Bush administration era.

    In "Critical Condition," a searing 2006 indictment of the collapse of our medical system, Donald Barlett and James Steele described how pervasive this dependence has become.

    Garage sales, spaghetti feeds, livestock auctions, pancake breakfasts, walkathons, bingo tournaments, pie socials, car washes, church suppers, raffles, barbecues, basketball shootouts, even hot-air balloon rides, all to help families drowning with unpayable medical bills.

    Rather than a coordinated national system, as every other industrialized country has established, our go-it-alone, you're-on-your-own society has hit rock bottom in the most basic area of all, the care of our communities.

    No wonder the U.S. ranks last among comparable nations in preventable deaths and first in out-of-pocket costs, despite spending twice as much as anyone else on per-capita health care.

    Much has been said about Franklin Roosevelt's first 100 days, a period that inaugurated a new standard of social action and set the stage for some of the most important reforms in American history.


    It's also worth remembering FDR's 1944 call for a second Bill of Rights, which included the right for all Americans to quality health care and other basics in jobs, education, housing and food that he said "spell security."

    Counting on personal check writers or online donors certainly relieves others of their responsibility, most notably the insurance companies who loathe to jeopardize their wealth by starting to actually pay for medical care.

    It circumvents the vision of those who think our government should guarantee health care for all of us, much as government already assumes a duty for our police, fire, armed services, schools, libraries, mail service, parks, environmental protections, airport security, national museums and prisons.

    Indeed, the government is already in the game of financing or providing medical care for seniors, veterans, the disabled and low-income families, and does it with less administrative waste, less bureaucracy and without rejecting people based on pre-existing conditions or dumping them when they get sick.

    But, somehow, a whole lineup of liberal advocacy groups, policy wonks, media pundits and politicians have concluded there is a national "consensus" to fix this broken and dysfunctional health care system by expanding the private insurance system that created the disaster.

    That approach, however, would not curtail skyrocketing premiums, deductibles, co-pays, or bills for care denied by the insurance companies.

    Perhaps those "consensus" builders are counting on the pancake breakfasts' and orphans' funds to make up for their policy failure.

    Or instead, they could channel that giving spirit into the growing campaign for real reform.

    Registered nurses will be in the forefront of this movement and nurses know what it would take to guarantee high-quality care for everyone — a streamlined, more effective system than our current nightmare, based on care not insurance, by expanding and extending Medicare to cover everyone.

    In an era when our government has already intervened on behalf of Citigroup and AIG and Freddy and Fannie and all those other financial wizards on Wall Street, maybe we can bailout the tens of millions of Americans without having to count on livestock auctions or widows' funds to pay for medical care.

    DeMoro is executive director of the California Nurses Association/National Nurses Organizing Committee and a vice president of the AFL-CIO and a resident of Contra Costa County.
  2. 3,743 Visits
    Find Similar Topics
  3. 30 Comments so far...

  4. 4
    jsrRN, Thank you for posting Rose Ann DeMoro's wonderful essay on Allnurses!

    It should prompt our collective conscience to reflect on who we are as a people and take action to create a health care system that reflects our moral and ethical values. Do we believe in equality? Do we believe in fairness? Do we believe in justice? Or are we just going to pay lip service to ideals and moral laws that have been codified as rules of social conduct?

    On the subject of healthcare reform, the debate isn't about facts, it's about values. The facts are easy. When health care is treated as a market commodity, only the rich can afford to pay for it. Competition among profit-making, investor owned insurance companies and HMOs has failed to reduce the number of uninsured and control costs. Mandates to buy defective insurance products are unconscionable and divert precious healthcare dollars from public benefit programs. Employers are dropping subsidized insurance benefits and with the recent economic downturn, the ranks of those without insurance are growing.

    We need to assure health care for all without adding to our nation's cost and the government's deficit in a way that reflects our collective values. We cannot claim that our rights to life and liberty and security are respected if we don't have equitable access to medically necessary health care.

    If this is to be the year of healthcare reform, it's time to put our values into action and invest in our most important natural resource: the people who live here. We have a single-payer, non-profit social insurance system that works in this country. It's called Medicare. It is more efficient at containing administrative costs than the bureaucratic, market-based insurance company model. We should improve and expand Medicare to cover everyone. Senate Majority Leader Harry Reid had this to say on Face the Nation last Sunday: "Medicare, a wonderful program. Perfect? Of course not, but one of the best programs ever developed to take care of sick people."

    H.R. 676 (The U.S. National Health Insurance Act), embodies an expanded and improved "Medicare for All" single payer universal health care plan. Nineteen other industrialized countries have some form of universal health care and they have better health outcomes. We have the opportunity to create a system that includes the best practices of those nations. The result will be a uniquely American system that we can be proud of.

    We're a good people, a compassionate people, and a generous people. It's time we mean what we say and act accordingly by passing H.R. 676. We're all in this together.
  5. 4
    Should we also stop relying on the generosity of individuals who contribute their time and money to the following causes: hunger, homelessness, poverty, drug abuse, disease prevention, health promotion, immunization, eye care, domestic violence, gang violence, literacy, public and private schools, mentoring, Big Brothers & Big Sisters, Boy & Girl Scouts, music, dance & art education, athletics, learn to swim programs, Meals on Wheels, visits to nursing homes and the home bound, Angelflight, Toys for Tots, ASPCA, PETA, service dogs,....

    What a sad world we would live in if we failed to help those in need or accept the gracious assistance of others, and pass it on.
    VivaLasViejas, Spidey's mom, lindarn, and 1 other like this.
  6. 3
    Quote from Jolie
    Should we also stop relying on the generosity of individuals who contribute their time and money to the following causes: hunger, homelessness, poverty, drug abuse, disease prevention, health promotion, immunization, eye care, domestic violence, gang violence, literacy, public and private schools, mentoring, Big Brothers & Big Sisters, Boy & Girl Scouts, music, dance & art education, athletics, learn to swim programs, Meals on Wheels, visits to nursing homes and the home bound, Angelflight, Toys for Tots, ASPCA, PETA, service dogs,....

    What a sad world we would live in if we failed to help those in need or accept the gracious assistance of others, and pass it on.
    No, the government should provide for all these services. The generosity of the individual is a characteristic that socialism does not advocate... Individualism. There would be not need for Individualism or collective individualism under socialism. Let the government provide for all your needs. Any the Boy Scouts requires young men to believe in a God anyway. .. Im being saracastic of course.. I agree with you
    Spidey's mom, Jolie, and lindarn like this.
  7. 5
    Quote from Jolie
    Should we also stop relying on the generosity of individuals who contribute their time and money to the following causes: hunger, homelessness, poverty, drug abuse, disease prevention, health promotion, immunization, eye care, domestic violence, gang violence, literacy, public and private schools, mentoring, Big Brothers & Big Sisters, Boy & Girl Scouts, music, dance & art education, athletics, learn to swim programs, Meals on Wheels, visits to nursing homes and the home bound, Angelflight, Toys for Tots, ASPCA, PETA, service dogs,....
    Of course, be generous. However, generosity, like love, can't be compelled. But public health and safety infrastructures require consistent and reliable funding for support together with public accountability for the proper planning and provision of vital services. I think you've missed that point.

    No decent and compassionate society should fail to provide health care to its members when it has the financial resources to do so. The United States is the wealthiest nation on earth and I think we share a common responsibility to be good stewards of the resources we all share. We have an individual responsibility, as part of the social contract, to support public policies that will enhance the collective health of all.

    In response to your rhetorical question, I will cite a verse from the Bible, Luke 12:48b, because it is probably familiar to many and as an apologist, I believe its message of responsibility, social concern, means, and benevolence towards others is universal among many of the world's religions. "From everyone who has been given much, much will be demanded; and from the one who has been entrusted with much, much more will be asked." (NIV).

    Different religions may have different cultural expressions of basic ethical principles, but collectively they cultivate a moral sense of social responsibility. For instance, the idea of the Golden Rule is not by any means confined to the Christian world. Buddism, Judaism, and Greek philosophy expounded this ethical maxim.

    Perhaps less controversial, is this quote from Dr. Marcia Angell, (Senior Lecturer, Department of Social Medicine, Harvard Medical School Former Editor-in-Chief, New England Journal of Medicine): "We live in a country that tolerates enormous disparities in income, material possessions, and social privilege. That may be an inevitable consequence of a free market economy. But those disparities should not extend to denying some of our citizens certain essential services because of their income or social status. One of those services is health care. Others are education, clean water and air, equal justice, and protection from crime, all of which we already acknowledge are public responsibilities."

    For me, it's a moral imperative, as a responsible individual member of this society to advocate for a single-payer system of universal health care. Simply stated, if you can, you should, because it's the right thing to do. And if you can't, we'll help you.
    Last edit by RN4MERCY on Jan 7, '09
  8. 1
    Quote from RN4MERCY
    Of course, be generous. However, generosity, like love, can't be compelled. But public health and safety infrastructures require consistent and reliable funding for support together with public accountability for the proper planning and provision of vital services. I think you've missed that point.

    No decent and compassionate society should fail to provide health care to its members when it has the financial resources to do so. The United States is the wealthiest nation on earth and I think we share a common responsibility to be good stewards of the resources we all share. We have an individual responsibility, as part of the social contract, to support public policies that will enhance the collective health of all.

    In response to your rhetorical question, I will cite a verse from the Bible, Luke 12:48b, because it is probably familiar to many and as an apologist, I believe its message of responsibility, social concern, means, and benevolence towards others is universal among many of the world's religions. "From everyone who has been given much, much will be demanded; and from the one who has been entrusted with much, much more will be asked." (NIV).

    Different religions may have different cultural expressions of basic ethical principles, but collectively they cultivate a moral sense of social responsibility. For instance, the idea of the Golden Rule is not by any means confined to the Christian world. Buddism, Judaism, and Greek philosophy expounded this ethical maxim.

    Perhaps less controversial, is this quote from Dr. Marcia Angell, (Senior Lecturer, Department of Social Medicine, Harvard Medical School Former Editor-in-Chief, New England Journal of Medicine): "We live in a country that tolerates enormous disparities in income, material possessions, and social privilege. That may be an inevitable consequence of a free market economy. But those disparities should not extend to denying some of our citizens certain essential services because of their income or social status. One of those services is health care. Others are education, clean water and air, equal justice, and protection from crime, all of which we already acknowledge are public responsibilities."

    For me, it's a moral imperative, as a responsible individual member of this society to advocate for a single-payer system of universal health care. Simply stated, if you can, you should, because it's the right thing to do. And if you can't, we'll help you.
    I love how people will use a quote from the bible to prove a point. "" From everyone who has been given much, much will be demanded; and from the one who has been entrusted with much, much more will be asked." (NIV). ""
    Interesting point. So for those who have been given much, much will be demanded.... I guess your using this quote to justify the government raising taxes to pay for the universal health care system you are a fan of ? I guess it could also mean , those who cant afford health insurance to use this entitlement responsibily also then.

    The next quote means from the Bible means only one thing to me/.. Those who are entrusted are the people who are our elected offiicals, they must make the hard decisions for what is best for our country now and in the future.

    Call me a mean person, but you also quote about the Golden Rule and social responsibility. Great Idea, I am for it. At the same time since we are going to use the Golden Rule to govern, lets not forget the other simple ten rules that God gave to Moses. The Ten Commandments. I am Christian, I believe in a small central government. As you probably guessed I am opposed to this universal health care on prinicipal.

    You speak of social responsibility, I agree with you . On the other hand, I see some people who live on welfare not because the economy supposedly sucks right now, but because the government provides for all these welfare receipients needs, so why would they have to work if me as a taxpayer is forced to give them money so they can go on having children, claiming disability from obesity, because they sat around all day and developed DM2 and will find a way to sue someone at the blink of an eye for extra money. These same people that I am social responsible for have children and even claim that the children have disability, so they can get even more money from me, a responsible citizen who works hard and is forced to pay more in taxes for the less services that the government provides to its citizens.

    You quote from a Harvard Dr. Interesting, her qoute reeks of socialism, from the get go..

    We live in a country that tolerates enormous disparities in income, material possessions, and social privilege. That may be an inevitable consequence of a free market economy.

    In our free market economy, someone worked to make that money to have disparity in income. Why should they penalized for earning that amount of money. They money they earn means jobs for others, those others buy goods and services that means money for others... etc. Like it or not we are going to have disparties in income, but I guess socialists dont like it. Material things are just that... things.. those things cost money, people spend money,

    I guess I am in favor of good reform to help those really need help to purchase decent health insurance. I dont believe the government should come in and take over an industry. I dont believe in free handouts, some people needs welfare, I am not opposed to that, but many abuse the welfare system.

    I am opposed to abortions as a form of birth control. I wonder who will be crying foul when taxpayers will have to flip the bill for some girl who has an abortion ?
    Lamie likes this.
  9. 2
    Quote from RN4MERCY
    Of course, be generous. However, generosity, like love, can't be compelled. But public health and safety infrastructures require consistent and reliable funding for support together with public accountability for the proper planning and provision of vital services. I think you've missed that point.
    No I haven't missed that point. The more I am "compelled" to provide "consistent and reliable funding" via taxes, the less money I have to donate to worthy charitable causes that are infinitely more efficient and effective than the federal government.

    For example, I support the local food bank. I shop from a list of requested items with a set amount of money that I budget each month. I deliver the food to my church where a volunteer transports it to the food bank and stocks the shelves. 100% of my dollars go to providing food to those in need. Not a dime is lost to administrative overhead, waste or corruption, something no government entity can claim. Every time my taxes go up, I have less to spend on this endeavor, and the food bank has less to offer to those in need.
    VivaLasViejas and Spidey's mom like this.
  10. 1
    Patrick,
    Small, central government? Hard decisions? Because you earn more money do you have the right to more justice? Should we create a parallel judicial system for the rich? We should have only one health care plan for the same reason we have only one court system. One nation, one plan. The principal of equal treatment demands it.

    Because you are the CEO of a giant drug company, for-profit insurance company, or hospital chain, should you be able to spend large sums of money to influence legislation that benefits you at the expense of all the other people living here? Most problems are complex, but there's nothing complex about simple equality and fairness.

    In the preamble to the Constitution, the framers set forth the fundamentals and guiding principles which the Constitution is meant to serve. It is often referred to as evidence of what our founders hoped to achieve. What does "promote the general welfare" mean to you? To me, it is a legal guideline about how the government should operate. The government should undertake to solve important social dilemmas for the common good. The concepts of universal equality in "higher law" tend to be intrinsic and qualitative such as the dignity and worth of the individual.

    Your arguments then, must be for a two-tiered system of government? Separate and unequal? One that benefits you if you have money, and fails to protect you from exploitation by the rich and powerful if you don't? And another one that exists in name only, just a bunch of nice words on a piece of parchment for the rest of us? Is that what you mean by small, central government? Sorry, Patrick, but I think the Supreme Court has over-ruled you on the separate and unequal.

    In a democracy, we're all entitled to equal protection under the law. Since the government is supported by our taxes, it exists for the benefit and protection of us all. It's a shame we still have to fight for it. Sure, there's a few welfare cheats, but their numbers pale in comparison to the fraud perpetrated on the people by an insurance industry that can't be regulated. It should be eliminated. Profit has no place and provides no added value in health care. The perfect should not stand in the way of the good!

    Are you aware that when Congress passed Medicare part D, the pharmaceutical companies who bought and paid for that law through huge campaign contributions, actually got a provision in the law that bans the government from using it's group purchasing power to get a volume discount on drug prices? And the elderly get to "choose" which plan is going to restrict their doctor's ability to prescribe the drug that's right for them? And, you've heard about the "donut hole"?

    A so-called "beneficiary who reaches the initial coverage limit falls into the “doughnut hole” or coverage gap and becomes responsible for the total costs of all medications. The statutory standard initial coverage limit was $2400 for 2007. This amount is reached by taking into consideration the full cost of the drugs, not just the beneficiary’s out-of-pocket cost-sharing. For example, if a drug costs $150 and the beneficiary’s co-payment is $40, the full $150 counts towards the initial coverage limit. The second calculation is the beneficiary’s out-of-pocket expenses. A beneficiary who incurs $3,850 in out-of-pocket expenses (OOP) in 2007, which include any deductible, co-payment or co-insurance, will arise from the doughnut hole and become eligible for catastrophic coverage."

    Wow! Cumbersome and confusing stuff, not to mention expensive. No wonder drugs are cheaper in Canada, and Britain, and every other civilized and indurstrialized country with a single-payer health care system. I hope that our newly elected President will be more progressive than the previous administration and urge the Congress, to repeal that mess. Then we need a fundamental change in our health care system. The Congress should pass H.R. 676!

    I have a hard time believing that you, or any nurse would pass judgement and turn their back on a young girl, or anyone else who needs health care. In the meantime, even though I disagree with you, I will be working as a patient advocate to change a system that is unjust, for the benefit of all of us. Bake sales and raffles? Well intentioned acts of good people, but it shouldn't have to be that way. We can do better than that.

    The tragedy of illness or injury shouldn't be compounded by financial ruin. By the way, the health care "tax" in a single payer system would be based on ability to pay; it would replace the current premiums, co-pays, and deductibles we now pay and it would be less than what we pay in most cases. Nobel prize-winning economist Paul Krugman has said that by eliminating insurance company waste and administrative overhead, we will have enough money to cover everyone with better benefits and be able to control costs.

    For starters, here's some money that your "small government" could be spending on health care.
    U.S. SPENDING IN IRAQ
    Spent & Approved War-Spending - About $800 billion of US taxpayers' funds spent or approved for spending through mid-2009. U.S. Monthly Spending in Iraq - $12 billion in 2008; U.S. Spending per Second - $5,000 in 2008 (per Senate Majority Leader Harry Reid on May 5, 2008); Halliburton Overcharges Classified by the Pentagon as Unreasonable and Unsupported -$1.4 billion. It gets worse. Click on the hyperlink above if you dare. And, don't forget, it's been over 5 years since Bush declared "mission accomplished." It seems like there's a lot of "big government" benefitting a really small number of the corporate elite to me. Where's the government of the people, by the people and for the people?

    So, what's your solution? Are you ready to go up against the likes of Paul Krugman? Or are you only going to be about shooting this messenger with blanks about religion and socialism?
    affffraidofamericans likes this.
  11. 1
    Quote from RN4MERCY
    Are you aware that when Congress passed Medicare part D, the pharmaceutical companies who bought and paid for that law through huge campaign contributions, actually got a provision in the law that bans the government from using it's group purchasing power to get a volume discount on drug prices? And the elderly get to "choose" which plan is going to restrict their doctor's ability to prescribe the drug that's right for them? And, you've heard about the "donut hole"?

    A so-called "beneficiary who reaches the initial coverage limit falls into the “doughnut hole” or coverage gap and becomes responsible for the total costs of all medications. The statutory standard initial coverage limit was $2400 for 2007. This amount is reached by taking into consideration the full cost of the drugs, not just the beneficiary’s out-of-pocket cost-sharing. For example, if a drug costs $150 and the beneficiary’s co-payment is $40, the full $150 counts towards the initial coverage limit. The second calculation is the beneficiary’s out-of-pocket expenses. A beneficiary who incurs $3,850 in out-of-pocket expenses (OOP) in 2007, which include any deductible, co-payment or co-insurance, will arise from the doughnut hole and become eligible for catastrophic coverage."

    Wow! Cumbersome and confusing stuff, not to mention expensive.
    On this, we can agree. Medicare Part D, like all government entitlement programs, was ill-planned, poorly written, bloated with waste and corruption and offers few, if any benefits to those it is supposed to serve. Regardless of your charges that "big pharma" insisted that the law be written to their advantage, it was elected government officials who wrote, voted upon and enacted this mess of legislation. Why in the world would you trust these same people with trillions more of your dollars in the name of another bloated, inefficient program that will benefit no one? Seems like that fits Freud's definition of insanity.
    RN4MERCY likes this.
  12. 2
    Quote from Jolie
    No I haven't missed that point. The more I am "compelled" to provide "consistent and reliable funding" via taxes, the less money I have to donate to worthy charitable causes that are infinitely more efficient and effective than the federal government.

    For example, I support the local food bank. I shop from a list of requested items with a set amount of money that I budget each month. I deliver the food to my church where a volunteer transports it to the food bank and stocks the shelves. 100% of my dollars go to providing food to those in need. Not a dime is lost to administrative overhead, waste or corruption, something no government entity can claim. Every time my taxes go up, I have less to spend on this endeavor, and the food bank has less to offer to those in need.
    Good for you! Jolie, you sound like a really compassionate person. It's really wonderful that you are as sure as you can be that not a dime is lost to administrative overhead and corruption. Vigilance is the key. On Charity Navigator and the American Institute of Philanthropy you will find that most charities, religious or otherwise, spend at least 25% of their income on fundraising (marketing the charity) alone. But, I digress.

    Everytime our insurance premiums go up, and our deductibles and copays go up, (which are, by the way, increasing much faster than the rate of inflation), we have less money to donate to worthy causes. And hey, when the insurance company refuses to let parents like my colleague, take her daughter (who suffered major complications at the company hospital), to an out of network hospital that has better brain cancer survival rates, that's a big chunk of money that no longer goes to charity and community support like girl scouts and t-ball. Yes, she's doing better now, but how's that for freedom of choice and quality, insurance company style?

    And then there's the hidden costs to consider that really take a bite out of our abililty to donate to worthy causes. If you're not fortunate, and happen to be born with diabetes, or hemophilia, or if you develop a chronic condition like asthma because of the polluted environment, or if you just happen to get cancer through no fault of your own, private insurers can just decide to exclude coverage for the medicine and care you need. Tough luck, sell the home if you have one, because you may get fired for taking too many "sick days," and pray that someone holds a bake sale to pay your rent and your chemotherapy. That's a lotta dough, pun intended.

    What about the 31% of every insurance premium dollar spent that goes for inflated executive compensation, administrative overhead, and marketing? Makes you feel better, does it, to think that out of $30,000 dollars in premiums at least $9,300 goes into some fat cat's profit instead of paying for the health care that someone needs? A fat cat insurance company that makes a profit by denying care? My friend Eve calls it "Murder by spreadsheet." Not exactly the kind of "charity" I want to spend my money on.

    Medicare is much more efficient and that's why I support the expansion of it. A majority of physicians, RNs, the national conference of mayors, and a majority of people now support a national health care plan, based on the single payer model... even if we have to raise taxes slightly to accomplish that goal.

    The government really can and does do a lot of things right! Because Medicare is provided as a not-for-profit social service, the overhead is less than or equal to about 4%. So the $30,000 dollars in taxpayer money actually nets $28,880 to pay for health care. The concept of one risk pool, with everybody in, and nobody out spreads the risk.

    Instead of paying premiums, co-pays, and deductibles to insurers, we simply pay one small tax, based on ability to pay, like a social (health care) security tax. Then we can budget appropriately, and not have to worry about those nasty, costly surprizes like insurance recissions and exclusions.

    It also makes sense to implement a single payer, guaranteed heathcare plan in this country because we will be able to cover everyone for all preventative and medically necessary health care at a lower cost than we're paying now.

    We can be more effectively "charitable" by acting in a politically and socially responsible manner toward one another in this country. I believe we can do that by implementing a tax supported, publicly accountable system of guaranteed health care. Wasting money on insurance premiums is not good stewardship of our collective resources. According to Dr. Claudia Fegan:
    In the United States today the pharmaceutical industry is more profitable than the gaming industry. The American public pays the highest prices in the world, while the same companies sell the same medications all over the world for prices 1/2, 1/3, or even 1/10 what they charge in the US. How long are we going to let this go on?

    People are losing their jobs because they can’t get care and can’t work as a result. They are having strokes and heart attacks because they can’t afford their blood pressure medication. They are having limbs amputated or winding up on dialysis because they can’t afford the medication to control their diabetes.

    People are dying because they can’t get the care they need. The insured and the uninsured are having care delayed or denied because we don’t have a health care system. Our county health system is so overwhelmed it takes months to get an appointment. There is no system in this country other than to deny care to those who need it. Access to care is a profit center controlled by the insurance industry. We pay them to limit access to care.
    It's immoral to continue to subsidize insurers. Mandates to purchase insurance are wrong because they've failed to control costs and expand coverage every time they've been tried. How much longer will we allow the pain and suffering and death from preventable illness continue when we know there is a solution?
    Last edit by RN4MERCY on Jan 8, '09
    Elvish and herring_RN like this.


Top