Complete overhaul is necessary. For example, mental health facilities can only be addressed on a federal level, same as healthcare. Otherwise the governments that do address them will get swamped with benefit received from across the country without the ability to collect taxes from the whole country.

The big ideas seem like wishes, but I think it’s completely doable. But a sizeable portion of the population opposes even the baby steps I listed, and I can’t deduce any reason other than they like to imagine themselves in the owner class and want to keep down labor.