Anthrax takes on the plight of the homeless on this track, as Joey Belladonna sings from the perspective of a man who has found himself on the street, seemingly invisible to those around him.

Anthrax drummer Charlie Benante is the primary lyricist in the band. In a 2017 Songfacts interview, he talked about the inspiration for this song: "At this time, we were starting to become aware of the homeless situation and the homeless problem in America. I remember going to play Portland, and usually on the days off, I would just go out to toy stores or record stores, just to go out for my day off and explore, and see what I could find. And a lot of times, I would see tons of homeless people. Everywhere. And back then, you really never got into the whole mental illness thing that was also going on, or the drug addiction, or how these were veterans who were basically tossed aside, and now were just part of society and we weren't taking care of them.

To this day, I know that problem still exists, because I just went to Portland and saw it again first hand. I don't know why I'm picking on Portland, it just happens to be on my mind because I just came back from it. We were just in LA, and I was in this area where the Wiltern Theater is, and there is a huge homeless section. It's hard for me to figure out in this day and age how we still have such a huge homeless problem, but I guess with everything - the economy, the drug abuse, the mental illness - we talk about it, but I don't think we ever really fix it. It's an ongoing problem, and I think this problem will probably always be here."

The video, directed by Paul Rachman, is striking in that it showed unvarnished images of homeless people around New York City. MTV wouldn't play it, but when Phil Collins released a stark video for "Another Day in Paradise" with similar images of the homeless, the network ran with it. That one even got a Grammy nomination for Best Music Video; the Anthrax clip was rarely seen until the emergence of YouTube.

"That was a novel idea," Rachman told Songfacts. "I was shooting a Method of Destruction video - it was a small video that was live. They were on the same label, Megaforce, through Island Records, and they had the same manager, Johnny Z, and the Anthrax guys were there. They'd already decided to hire me for 'Who Cares Wins.' They wanted to work with me.

They had this homeless idea. In the mid-to-late '80s, the homeless situation, it's dire now again, but back then it was very dire. They were everywhere, and it was intense. New York hadn't fully recovered from the fiscal crisis and the crime of the late '70s. It was still slowly emerging from it. The Tompkins Square Riots happened around then. Union Square had been closed off because it had become a homeless city. They surrounded Union Square with a giant chain-link fence and boarded it up just to keep people out so they could renovate it. So gentrification was starting, and it was really squeezing the homeless. In "Who Cares Wins," Anthrax really wanted to showcase the homeless problem.

That was a difficult video, because that's not an easy story to tell. It's a sad story - it's not like happy, cool, let's rock out. It's a serious issue, it's a serious song, and I treated it that way. So it had a dark heart, that video, rather than maybe a hopeful heart."