> we are at war with many countries all the time, most of it is cold
Like whom? We (and let's be honest, every other great power) are at war with many countries all of the time, and while they may be cold for long stretches, they absolutely (a) go hot from time to time and (b) are constantly threatening to go hot.
To me "war" is a state of "no rules" hurting. IE nuclear, biological, any weapon goes. Anything less is an exercise in restraint - even if still quite terrible in it's own right.
Which means there are lots of "exercises" of varying lethality, risk profiles, spheres of influence, etc. And yes many countries are jockeying against other countries in varying ways.
Large scale scams against other countries could be seen as an unintended (not a planned government action) exercise that is condoned by the government.
It's pretty obvious to everyone that doctors have been abusing these levels. See doc for 20 minutes for a low complexity item but get charged for a 30 minute medium complexity. The insurance companies aren't blind. They've got the stats in hand for each doctor. I mean some of the ranking data is already built into the portal tools they give consumers for finding a doc.
It's a huge system with a lot of people involved so no doubt there is abuse, but there is also natural and expected levels of variation in the complexity of patients that doctors doing notionally the same job will actually encounter. If you're doing an honest job and happened to have seen more complex patients than average I think you'd rightly be pretty angry if you were then forced to do more paperwork to justify yourself to an insurance company who starts downcoding your patients.
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