As I see it, The USA is in a deep hole. Here's what we need to reform in order of importance.
1. Elections: Do away with the electoral college. Eliminate PACs.
2. Finance: Hit the wayback machine button and send the laws back to before Reagan and Clinton deregulated the finance industry. The Fed needs to actually police the financial services corporations.
3. Drug regulation: Adopt a libertarian approach. The "war on drugs" has been an expensive failure.
4. Patent law: We have a corrupt, inept patent system. Fix it so that the big corps can't patent breathing.
5. Immigration: We need to make it easier for honest, productive people to immigrate. We need an efficient guest worker program as well.
6. Heath care: We need some kind of affordable health insurance for all citizens. Probably for the guest workers as well.
I put health care at the bottom because we won't be able to do it without major changes to our election laws. We have the best government money can buy and until that changes, most of our efforts to fix the other problems cannot proceed.