Play it like me in VATS and 3 person view only. Makes it feel like an RPG where stats, perks and numbers count. Leave the CoD first person view game play away. No matter how hard devs try they can't make enemies as good as some shooters.
Choose weapons and armour more for the looks instead of stats.
Don't snipe all the time and run around in power armour.
The game is not very hard but it doesn't force you to use "the best" items and builds either. At least for me this is more important than anything else.
Unfortunately, even without the sniping and PA combat is still fairly easy, since the AI's vocabulary does not include the word 'tactics'. A well-armored lemming is still a lemming, after all.
For at least some of us, the balance discussion is not so much about combat in particular (although we do think it needs improvement), but rather about how the game system said combat is part of makes it (too) easy to become excessively powerful compared to even the toughest opposition. I don't play on VH because I loathe 'bullet sink' foes, but given that it's not hard to amass thousands of any one caliber of ammo I'm sure it wouldn't be any more difficult than the Normal I always play at, and that's a real problem IMO.
One of our main complaints is how the 'difficulty slider' fails spectacularly at its job as we see it- rather than making ever-hardier foes it should be regulating supplies, altering the difficulty levels of skill checks, altering SP per level, and so on. If it worked this way then the 'Hard' part of Very Hard would actually
mean something, and currently it really doesn't.
There's also the fact that the increasingly high level cap means characters will become less and less diverse as more and more skills get capped out, which we feel heavily diminishes the 'Role' part of Role Playing Game. To us, a major part of our play comes from building our characters according to what we want them to be, such as a Cowboy or Scientist, with the attendant perks and skill choices; the ability to max 8-11 skills by level 35 without really trying means that instead of one or the other you have both, which kills character diversity. Granted you have to be a bit more careful with perk selection in F:NV, however at L50 you'll have 25 picks and will likely be taking 'filler' rather than continuing to build up the character.
Basically: we want our choices in character building and difficulty selection to be meaningful, and currently they really aren't.