If Bioware had gotten the rights to Fallout and made Fallout 3?
I think the Bioware mindset would not have made as good a wasteland as Bethesda which is full of content, and as you would expect to see content strewn everywhere and stuff that could be dug out of the rubble.
I think the Fallout 3 that we have now is kind of the definitive version of how Fallout should have been done and structured. That's not to say that this Fallout 3 is perfect, there are many tweaks to be done, but the overall of how this Fallout 3 game is close to a perfection that is very hard to fault, apart from the tweaks needed.
What's needed, well I could get a bit too invincible later on, so maybe tweak the SPECIAL and Perks a bit and/or have an even harder level. Having said that, you can restrain yourself in taking the most powerful weapons and armour, and stimpacks, things like that. I managed to keep my game pretty hard all the time that way, and no companions to help as well ... but a harder level I would prefer or just generally overall harder, though when straight out of the vault it was very easy to get wasted (on VH).