4e, more so than any version of D&D since the original, sacrifices realism for playability.
Inaccurate.
4e, more so than any version of D&D since the original, is self-aware that it is unrealistic, and instead seems far more informed by the genre it's supposed to try to emulate.
In particular ,4e sacrifices things for balance, so tweaking and adding various house rules can easily have unintended consequences where one class or race get affected more than others.
Of course, the rules occasionally get it wrong, and then should be adjusted, but only with extreme caution lest the game get out of whack with one character getting too much benefit or penalty relative to others.
And the rest are issues inherent with every roleplaying game ever.
I don't agree with this. It sacrifices simulation for playability, but realism can be preserved (for those who care) provided that players and GMs adopt a flexible approach to narrating the gameworld.
This can have other sorts of implications for play - for example, if narration and mechanics are signficantly divorced, Gygaxian-style skillful play becomes harder - but I don't see this as a realism issue.
In fact, dare I say, Gygaxian-style 'skillful' play is as divorced from attempts to facilitate realism as possible.
And as for the 'simulation' vs 'playability' let's settle this here and now.
When most people say 'simulationism' they really mean 'ability to game more elements of the world.' This is a personal pet peeve... 4th edition is not more 'gamist' because it doesn't attempt to make everything into game elements... it's the
lack of game elements to describe the game world that define 4th edition in terms of narrativism.
A perfect example is how towns and the economy work.
In 3rd edition, you checked the size of the town, rolled on a couple tables to see what gp budget was available to buy/sell, checked the character classes of present townsfolk to ensure the availability of item creation feats were there.....
...in other words... the town was described and built based on its ability to interact with the game mechanics and terminology. I.E. literally gamist. Sometimes the results stretched plausibility, but you accepted it, because the game rules told you that's how it was. And players would actively say stuff like 'Look, this town has so-and-so thousand people so we MUST be able to unload a 10000gp sword on them at full price!' and then feel cheated if the plausibility of it prevents their 'rights'.
4th edition: The town is what you need it to be, for the reason you need it to be. If that town is in economic strife because the merchant routes are under siege by orc invaders, then there's no way you're offloading that sword... no one can afford it. Why? Because it makes sense, that's why. Game rules be damned!