Kobold Boots, interesting that you mention the bloodied mechanic, which opens up penalties (monsters get special attacks on you) and options. In a way that makes hit points a little more verisimilitudinous than they have been previously.
That works well for 4e, given how quickly wounds heal and that a sergeant shouting at you can cure them.
The problems with this approach (thinking of all editions here) are:
1) Why do paper cuts require so much healing magic to cure? For example in 3e a 100hp PC on 1hp would need more than 10 Cure Light Wounds spells to be fully restored.
2) Why (at least prior to 4e) do they take so long to heal?
3) The player becomes dissociated from the character, to use the Alexandrian's phrase. The player knows that his PC on 1hp is close to death, but the character doesn't. Metagaming is required.
Wounds healing in six hours and being cured by warlords are probably the two major issues people have with verisimilitude in 4e. They suggest hit points that are less physical than they have been in previous editions. Though, paradoxically, due to the bloodied mechanic, hit point loss that stays above zero now has more of an effect.
My response to this (and you're on the money with your take) is that with every edition of D&D, when you choose to play it, you also choose to change your worlds view of how the numbers operate and what the numbers represent.
I've already stated that HP in 4e are abstracted to represent everything that a character is in combat. That includes endurance, tenacity, capability, innate reflexiveness in combat etc. So that does work well in context of the bloodied mechanic. Now to jump off of the whole damage conversation you've gone into healing, which by function is in the damage continuum but by design and effect is magic.
Why does it take so much magic? Because magic changed too.
The inclusion of Rituals slowed magic down in both scope to cast and overall power on the battlefield. Sure, people spent time developing spells that hit stuff, just like our society spent time on nuclear bombs prior to nuclear medicine. As a result you're going to get less bang for your buck.
The Alexandrian's approach is that a wound is partly physical and partly non-physical. Say a 10hp blow means 1hp of real injury and 9hp of 'luck loss'. But how can the warlord cure that 1hp of real injury with his Inspiring Word? Could any real injury completely heal in a day? However I don't see a shift from 90% abstract hp to 100% to be that big of a change.
Well it depends. In a world of factual modern terms, inspiring word can't heal anything except psychological wounds. In a world of magical fantasy there's no saying that the Inspired Word isn't at least partially enhanced by the magicness of the realm as an extension of the Charisma of the Warlord. Could any real injury heal in a day? Ask the gods.
I think that a lot of the "reality" complaints come from people that are so far removed from seeing the magic in the real world (and I mean the wonder of people and awe in nature) that they can't possibly think about magic in a world where it's supposed to exist..
