For example, I think the DMG needs some discussion of how to narrate combat and how variations in that technique generate different a different tone in the campaign. For example, if every "hit" is a solid hit instead of an experienced dodge that turns an otherwise lethal strike into a bruising glance, then high level characters will end up absorbing heroically (or comically) large amounts of unrealistic physical injury.
I agree. But, my narrative view is slightly different.
Years ago pre-4E, I came up with a concept of Cure Light healing 25% of damage, Cure Moderate healing 50% of damage, and Cure Critical healing 75% of damage.
It didn't matter if a Cure spell or potion was used on a commoner, or a King. They both healed the same relative amount.
This is how I view damage in 4E.
PCs are actually getting damaged to some extent. A 50% hit point shot at level 3 is identical to a 50% hit point shot at level 23.
To me, such a shot is not a minor bruise. It's a slightly cracked rib and the reason PCs run out of healing surges is that there is only so many slightly cracked ribs that a PC can have before attrition sets in.
If 100% of hit points means that a PC is unconscious, that PC is not fatigued. That PC is not asleep. That PC is seriously hurt.
Even in 1E, hit points were not just damage, they were a series of detrimental effects. But, they were still damage as well.
4E has for the most part, removed damage from the equation almost completely for hit points. A PC is only really damaged if s/he fails 3 death saving throws and dies. Otherwise, the PC is napping.
Every hit should not be a "solid damaging hit". But, hits should still do damage, even if it is minor bruising.
The game mechanics should mirror the narrative that hit points represent. It's not just luck and it's not just dodging. It's also actual damage.
For ease of game play, the designers said "Oh well, a PC can use as many healing surges as required to get fully healed during a short rest" destroys the narrative when the PC was 1 death saving throw away from dying a moment earlier. I would prefer that 4E put some more magic back into healing, at least if the DM wants to play a grittier more narratively plausible game.
These are aspects of D&D that I think lost their way in 4E and I think that the game system should have optional rules for this type of thing. A 4E version vs. a pre-4E version as options.
For example, an optional rule that a Warlord cannot do more than just hand out Second Winds. The Warlord is not actually healing his allies in a grittier game, he's merely encouraging them.