(chiefly, US) To make the decisions; to be in charge; to give orders.
In today's health care system, insurance companies call the shots. They pick whom they cover and how they cover them. They can cut off your benefits when you need your coverage the most. They are in charge.
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Regional slang from around the English-speaking world — British, Australian, Irish, Caribbean, Nigerian, Filipino, AAVE, and the hyphenated-English dialects that make the internet sound local.
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