Suggestion:
Change the difficulty level in a couple of ways. Leave the slider as is for Very Easy – Very Hard. Survival is no longer an option on the slider bar. There are separate check-box options now to add two modifiers. You can choose either one or both.
Survival – You now have food/water/sleep timers and healing speed is greatly reduced (just like Fallout:NV). The timers are the same regardless of difficulty level chosen.
hardcoe - Ammo and non-addictive health drugs (Stimpacks, rad-X, Rad away), and meat from animals now has a 50% chance to not spawn. Each point of luck would improve this chance by 1%. Buying and selling is 20% harder.
So how this works: you could play normal + survival, or normal+hardcoe, or normal +hardcoe+survival. If you really wanted a challenge bump it up to very hard+hardcoe+survival. If you just wanted it to be more challenging without having to worry about sleep timers etc go for very hard + hardcoe… Get it?
This way players can choose what option works best for them and it adds replayability. I know mods could fix this, but I’d like to see it officially. Honestly, this wouldn’t be all that difficult for Bethesda to implement. And I’m on XBOX so mods could still take a while to show up. Besides, it’s about time Bethesda tried a new approach to difficulty level.