What's your biggest issue that would cause you to vote for someone?

Honesty.

Integrity.
If I were to find someone with an articulate philosophy towards government who consistently advanced same, I would vote for them - unless it was killing people named "Stoneking."

I am only slightly tongue in check here. I believe the #1 problem with government by far is lack of integrity. It shows up in many ways, but the biggest are
1) People who say whatever they need to say to get elected
2) People who do whatever they need to do to stay elected

Neither of the above things serves the county well, in my opinion.

At this point, I would (semi-)happily vote for someone I disagreed with on 10 out of 10 issues, as long as I though that they were sincere in their positions and would act in accordance with their beliefs. You can at least plan for them.

And fiscal accountability. I have no hope at this point, however, as everybody wants "free" stuff and nobody want THIER ox gored.

I have to agree with SFC (Join to see) , fiscal responsibility is probably the top priority at this point in time, but by no means the ONLY issue (although I believe this alone would make a marked difference in the job situation in the private sector in a short period of time). We also need a drastic revision in foreign policy and border security (a tie for second at this point in time). You mentioned Healthcare, the current ACA is, in my personal opinion, unsustainable and needs a revamp; but it may just implode on it's own forcing a revamp. As for the VA; I am of the mindset that the VHA (Veterans Health Administration) would be better off being privatized. I don't necessarily feel the same about the VBA (Veterans Benefits Administration) or the NCA (National Cemetery Administration).
The current situation, to me, is that there are so many issues out there; and if everything is a priority, nothing is a priority; making this decision all the more difficult.