They're both basically just ergonomic issues at this point, with prefixing names and always setting lexical scoping being cultural norms.
Yes! Prefixing names as a way of emulating namespaces generally works well enough. We could get modules support the same way JS used to have them, ie. as hashes of closures. Or we could use something like the `nameless` package, which rewrites the code to add a prefix to definitions automatically. Yet nobody seems to be doing either: it's just too much of a pain with too small a gain. The situation would be different if we got first-class module support in the language, but if we're going to only emulate it anyway, then namespacing with prefixes is just the easiest way to do it that is still "good enough". Still, Racket-like modules would be great to have, can't deny that :-)