They know very well what they are doing. It’s just that their wealth isolates them from the consequences of it. They don’t care about healthcare, climate change, education, unemployment, because that’s for the 95% to worry about. They are rich enough to don’t give a fuck, and they feel safe doing so.
And that rather obviously describes someone who's rather obviously mentally ill.
Specifically, they lack empathy and have little to no conscience, so have little to no concern for the harm their decisions might cause to others. Those are the hallmarks of both antisocial personality disorder and psychopathy.