Don't miss Pascal Costanza's opinion in the comments, to put things in perspective from an expert Lisper:
My impression is that you [haven't used] neither Common Lisp nor Scheme on a regular basis, and/or in a considerably sized software project. Most of the issues that you mention are "academic", in the sense that they are theoretical problems which tend not to bite you in practice
I am particularly amused by this guy's ranting about hygiene and macros. I have written quite a bit of lisp, and debugged plenty of macros, and once you have some experience with gensyms you really don't look back and wish there was a hygienic system.
Hygienic macros are a bigger deal in Scheme, where everything is conflated into single namespace (you know, the land of LST). His rant about macros and namespaces is a good hint he didn't practice Lisp that much.
My impression is that you [haven't used] neither Common Lisp nor Scheme on a regular basis, and/or in a considerably sized software project. Most of the issues that you mention are "academic", in the sense that they are theoretical problems which tend not to bite you in practice