I finally broke down and picked the game up -- ultimately, I'm a whore for cyberpunk.
About 30 hours into the game, I feel completely justified in standing by my earlier claims of "oblivion with guns". Granted, it's a somewhat improved oblivion with guns, but it's still oblivion at the core.
I'm glad to see that Bethesda can convincingly pull off the post-apocolyptic cyberpunk feel. Nothing could be more different in design aesthetic from their previous titles, and it works very well.
The AI and vioce acting is much improved. I've yet to run across any "talking to myself" conversations other than deliberately anonymous trash NPCs, and no instances of out-of-character tone switching. The only one I did see was a very obvious switch between two completely different voice actors, and it had an in-game explanation, so kudos. I'm glad to see NPCs having more personal and directed conversations with each other (Nova and Moriarty, for example), and overall I like what they've done with the dialogue engine now supporting unique responses for stat/perk checks. This goes hand-in-hand with perks like Child at Heart, which a lot of people find useless but I happen to enjoy for the extra role-playing of having unique character interactions. I like that they made the avatar more personal by having subtle dialog changes to reflect the gender choice you made at the start of the game.
VATS is a mixed bag. I can never get enough of slow motion ragdoll physics, so I don't mind that aspect of it. It annoys me that vats is "optional", and by that I mean you can go through the game without touching it, but you'd be a fool to do so. It's like how you can play Ken without using the shoryuken, but why in the hell would you want to? VATS is too powerful relative to non-vats gameplay, though since I've played a ton of games with cone of fire implementations I'm used to the inaccuracy at range.
The stats are... yeah. Some of them are entirely useless, and it upsets me that there is now a definitively optimal character to build that is outright better than all others. As I said, unique perks that help define a character are there and they're nice, but there's just too many clearly superior options for perks, skills, and stats. For example, the radiation-related perks are all useless, because rads don't really factor into the game if you're not dense. Charisma has very little if any effect on the game, even for dialog, so there's no reason to put points into it. They could have done a lot better on that.
Animations need work. Lots of it. There is absolutely no excuse, in 2008, for reload animations to sometimes repeat parts of themselves for no reason at all (try spamming reload with a laser pistol).
All in all, a decent game, and one I'm enjoying mostly for the setting and story. It solved a lot of my major gripes with Oblivion, but then turned right around and broke some things that were working just fine. But it's still just Oblivion With Guns.