Vats is silly, I think most of us agree, only I don't think Obs will be allowed to touch it since it was one of the big selling points for the game. It tries do retain action points and elements of turn based combat, but it doesn't work. It's a free for all, the enemies just stand around and watch their heads explode.
I think we can hope that the size of your stimpack stash is not going to be the all overshadowing factor of whether you live or not.
Were I king I would replace VATS with a called shot feat. One shot at increased accuracy/crit with a cooldown factor, say 4-5 seconds of actual game time.