aside from balancing the effectiveness of firearms (guns vs energy weapons or explosives for example) i think it'd makes sense to reward a character with an appropriate free perk for increasing any skill to 100. eg, get medicine to 100 and get rewarded with stimpacks that heal in 3 seconds instead of 6, or SOMETHING to make that skill worth maxing out.
while i'm at it, why can't they do the same with sneak that they did with speech? what i mean is, why can't stealing from an NPC require a certain level of sneak skill for immediate success? or perhaps you could still attempt to steal from them with a % chance based on how much lower than the required amount your skill is.
basically the point of this thread is - how can we make it appealing to take any/every skill to 100? so we can effectively base a character around any skill specialization.
