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"Your power to choose is made supreme where it really matters--the choice of health institutions and professionals."

What does "where it really matters" mean?

Is it an adverb? If so, an adverb for which part of the sentence?

  • The example (from some inferior Philippine-based English teaching aid) doesn't reflect natural mainstream English. We wouldn't normally use the words is made supreme in such a context, but since I'm not sure exactly what the writer intends it to mean, I can't really suggest better phrasing. Maybe ...gives you the final authority [when it counts], but maybe something else. – FumbleFingers Mar 1 at 14:42
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I would say that, in your sentence, "where is really matters" is adverbial phrase. It tells where your power to choose is made supreme.

As for the meaning, we often use the phrase where it matters to mean in the times or places that are most important or significant. Macmillan defines the phase like this:

it matters (phrase) used when you are talking about whether something is important, or about whether something makes a difference

Some example usages in Macmillan include:

“I’ve forgotten my swimming stuff.” “It doesn’t matter – you can borrow these.”

Here, the phrase "it doesn't matter" means "it's not important" (because, in this case, the person's friend has some swimming stuff that can be loaned, so the outing won't be ruined after all).

I don’t think it matters that he hasn’t got a degree.

Here, the phrase is used in the negative, and it means that the person looks qualified even though they have not yet earned a college degree.

A charitable community blog was titled:

Make a Difference Where It Matters

That means the foundation can help you give to a community organization that is most important to you.

A synonymous phrase would be where it counts. One news article says:

In today's digital world, singles are so busy matching that they're not actually connecting in person, where it counts.

As a footnote, in addition to saying where it matters, we can also say phrases like why it matters, or when it matters. For example, in February of 2019, Forbes magazine published an article with the headline:

Indra Nooyi Joins Amazon's Board ― Why It Matters For Women

and a sports column reads:

He's at his best when it matters most, in the team's biggest games, especially in the playoffs.

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It's talking about how the importance of a choice, makes the choice you make have much more impact on you.

You have lots of choices every day - whether to have cereal or toast, which radio station you listen to - that have very little impact by themselves, and could be argued that if you didn't have that choice, wouldn't change your life much.

Big decisions - which college to go to, what subject to study, profession to follow - have an impact that could last your lifetime, so in these cases, the power to choose is so important as there is such a massive consequence.

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