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People have been convinced that their votes don't matter, protests don't matter, etc etc etc
"They're both the same" (in reference to parties) is the extent of most people's political sense.
It's also one of those things where there are enough safety nets and things that for most people it's never really that bad. I don't know anyone personally that's actually lost everything from medical debt. I know it's a possibility and that's scary... I even know some people that are on every aid program out there basically but those programs are paying out the thousands of dollars in monthly medical bills (i.e. in the instances I know the system actually "works" on some level albeit uncomfortably and with a lot of stress).
To put things into context for someone who doesn't live here ... car crashes, cancer, heart attacks, and other rare "inescapable" things like that are all much much more prevalent than crazy medical debt, getting shot, or going homeless.
It's not a dystopia ... most people are living at least decent lives. That's kind of the problem, it's not bad enough for an overwhelming majority of people to actually care.
That leaves some number of people who actually care for the sake of others and some number of people that care for their own sakes to deal with the problems and the propaganda that influences the (mostly) apathetic faction. The people at the bottom of the whole thing are also in the worst possible position to do anything about it because their time and credibility is ultimately judged and scarce when it comes to doing things like going out and convincing people to vote in their favor.