There seem to be an unintentional and very-inefficient interaction between our attempt to defend the frontend storage space from large objects at the top of wm_admission_policies, and the code in vcl_pass which randomizes the backend selection for all pass-traffic. This causes backend chashing to be ineffective for all of the large objects where it probably matters the most.
It seems like this should probably be implemented as hit-for-miss (which is how the exponential strategy works), but using the full TTL (since it's not probability-based), and probably needs to be wrapped in the same "200 miss" conditional as the exp code as well, to avoid affecting true passes? Attaching a proposed patch here, but this is a complicated area and I wouldn't be shocked at it needing further debate and analysis.