I decided to give this game a shot. I won't be back online at home for at least a month and wanted something to play to kill the time. I'm about 2 hours in so far. I went through the school and now I'm exploring the first city.
So far, I'm pretty impressed. Some of the writing is still terrible but it's so far past Oblivion that no comparison should be made.
VATS is a great implementation of turn-based fighting into a real-time game. You want to play it like classic Fallout? You have the option. You want to play it as a real-time shooter? Go for it. Personally, I'm not one of those who clings to turn-based games so this is a plus to me. I find myself playing it as a hybrid depending on situation.
Third person perspective is still broken. Not as bad as Oblivion, but not good. Screw you, Bethesda. Fallout is not a first person franchise.
The world so far is pretty impressive. Bethesda did a very good job of recapturing the Fallout world in 3D. Kudos to them for that.
There aren't the cool options of the old Fallout games. No child killing, prostitution (hooking yourself, that is), etc. We all knew that so I won't dwell on it.
Combat choices... Bethesda still didn't get this right. There is no way to avoid combat in much of this game. Weak, really. That was one of the strongest points of the Fallout franchise and it's sad to see Bethesda miss the mark so badly.
I'm playing this on hard. In general, it should be harder than it is. There are a few difficult moments, but overall I'm walking through the first bits without much effort.
Melee combat is still broken. I fought a collection of ants (about 10) that should have kicked my ass. I was hit once by strafing around them with a baseball bat and swinging. Killed every last one of them in about 3 minutes. WEAK.
Overall, this game isn't nearly as empty or lifeless as Oblivion. Some of the parts are actually difficult, as well. Not quite where they should be, but better than Oblivion. I'll keep posting as I play this more.

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