The scale of potential disaster is much lower now than then. We have many times fewer nukes, and counterforce is supposed to work a lot better for the attacking side leaving even less to be thrown on cities.
It will only kill high tens of millions of people now, instead of hundreds!
It's an improvement, but not much of one.
Also, consider the aftermath of nuclear war. Consider how many people live in cities. Consider that cities are not at all equipped to survive without massive, and consistent shipments of food, water, and electricity.
We'd be lucky if billions, not millions, of people didn't die in an all-out nuclear war between the US and Russia. It's still debatable whether any humans anywhere in the world would survive.
Long term, yeah. The ensuing nuclear winter would effect the entire planet much more than was thought in the early Cold War [1], which would absolutely affect food production. Add in the fallout, and your long-term forecast looks pretty bad.
Right now yes, nuke forces are crippled and no longer sufficient to do their job in many cases. Essentially they are sufficient in just one case: Russia finds itself in unmanageable situation and attacks countervalue first, in a deliberate suicide to take everyone else with it. To me it seems highly unlikely. In all other situations, nukes will simply play too little role with every possible conflict fought and won without or with very minimal use of nukes.
They didn't update for 30 years after all, and conventional smart weapons evolved a great lot in the same period. Nukes are almost not needed for counterforce (almost, because area targets such as sub bases and mobile ICBM garrisons are still better attacked with airburst nukes, but these are so low number it will be inconsequental from humanitarian or environmental standpoint).
While our (and presumably Russia's) counterforce capability has improved, a lot of likely counterforce targets are still near major population centers. An all out counterforce exchange would result in tens of millions of civilian casualties. Such an event would probably end our way of life (speaking as an American).
I think that the 1960's plans called for Moscow to be struck by about 400 warheads. Perhaps the modern ones call for less than 10, no one who knows will be able to comment I guess. In any case, not a great day to be in Moscow, London, Los Angeles, Paris... Perhaps casualties will be lower than the second world war, but I doubt it, and my guess is that they will be much higher for civilians, and that the injury count would be perhaps ten times higher due to flash burns. In any case my guess is that everyone who reads this would know people who will die in such a conflict. Not an exciting or positive thought.