Patriarchal Heteronormative White Supremacy is the top-ranked constraint for the fascist evangelical death cult
They do not care if they themselves don't get health care or die painfully, they don't care if the planet is destroyed or polluted, they don't care if their own children have a worse life than they did or grow up hating them. They will suffer untold material misery in order to feel superior over people of color, LGBTQ+ people, non-cis men, etc. They will reject universal health care, welfare, student loan forgiveness, any social program **even if it would benefit them personally** out of spite/anger that someone not like them may benefit. This is why they are a death cult.
They mask this fundamental truth with misdirections, like that human beings are completely in control of their destiny and deserve every bad thing that happens to them (or perhaps it is because Personal responsibility rhetoric is a fear response) so that they don't have to face the reality that they would rather hurt themselves than help someone not like them. They obsess over self-optimization in order to stave off fear of the universe's chaos and bad luck.
The idea that all people on this planet matter, that every life is precious, is so abhorrent to them that they will cut off their nose to spite their face every time.