The complexity of this game has surpassed non-optional permadeath

No.
Simply because you can explore a building, die from whatever reason and quick-load a save. Ta-da you know where the good equipment is.
“Nothing interesting in the north road, better quick-load and take the south bridge!”
“Bionic installation/mutation gone wrong? Just quick-load a save and try again” (happened in FO3 with the conversation stuff) This applies to conversations and crafting (and possibly other things I cant think of)

Fallout 3/NV has a quick-load option because all the rooms aren’t randomly generated. That mininuke is going to appear in the same spot everytime you start a game.