In the Introduction, Jonathan M. Metzl introduces the paradox of white, working-class voters supporting politicians and policies that harm them. Metzl asserts that under the guise of making “white America ‘great,’” conservative figures like Donald Trump negatively impact their base of white, working-class Americans.

Metzl spent years traveling through states like Missouri, Tennessee, and Kansas, learning how people with anti-government or pro-gun views navigated the effects of these conservative policies. Despite the apparent polarization of the US, Metzl discovered that many red-state voters were open to compromise and even “longed for a middle ground” (2). Gun owners in Missouri supported background checks, African American men in Tennessee wanted the Affordable Care Act, and self-described Tea Party Republicans in Kansas endorsed tax increases to fund public schools. He suggests that individuals with seemingly divergent views might be able to find common ground if “left to their own devices” (3).

However, Metzl also found that lower- and middle-income Americans repeatedly supported policies detrimental to their own well-being. One example was Trevor, a 41-year-old uninsured Tennessean who supported Tennessee’s refusal to adopt the Affordable Care Act, despite suffering from chronic illness.