How much of that is due to the programming practices he espouses, I'm not sure. Ironically, if he went all-in on OOP with Smalltalk, I could see the super productivity that environment provides actually making it harder for him to finish anything, given how much it facilitates prototyping and wheel-reinvention. You see this with Pharo, where they rewrite the class browser (and other tools) every 2-3 years.
But his track record doesn't support the reputation he's built for himself.
> for game projects
That's the problem. Casey holds up a small problem domain, like AAA games, where OOP's overhead (even C++'s OOP) may genuinely pose a real performance problem, and suggests that it's representative of software as a whole; as if vtables are the reason VisualStudio takes minutes to load today vs. seconds 20 years ago.