This was really more an exercise in thinking outside of the box. Yes, I understand the D&D Sacred Cow Holy Trinity (6 Classic Attributes/AC/HP): With These, We, The Masses, Shall Not Tinker. And yes, I'm sure there ARE other games out there that complicate the hell out of things. I wouldn't know. Haven't played em. I like D&D just the way she is, but surely there's nothing wrong with poking the status quo with a big stick, right?
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Oh, I poke. Boy do I poke.
The Unearthed Arcana that had a vitality system is a pretty popular solution from over the years. Basically you have hit points, which represent thinks like skill, luck, stamina, and such, and you have vitality points, which are actual health.
But the issue for me hasn't been the healing rate, etc., it has always been that you can have 150 hp, or 1 hp, and there's no difference on your ability to function.
The 5e rules made this super simple for me to tweak, but it's not for everybody. I use an injury system based on the exhaustion track. You recover using the death saving throw mechanic, but you get only one save at the end of a long rest. So an injury will last for at least several days.
Of course, this also required altering the healing system.
I've gone much farther - Armor is a combination of AC and certain resistances depending on type, and a system similar to the UA system that makes attacks a contest. It's not always a contest, but you can opt to parry an attack directly. In addition, each round you have your STR and DEX modifiers that you apply to an attack or AC. You can split it anyway you'd like.
Hit points max out between 8th and 12th level depending on race (Constitution bonuses still apply at levels higher than that).
So you can decide how much you want to tinker. Just be aware that any system like a vitality system does greatly alter the game, particularly at higher levels, since it bypasses hit points entirely. You can have 150 hp, but with my injury system you only have 6 levels of injury. You do get saving throws to avoid them (usually - falling gets tougher the farther you fall). It makes for a very different type of game.
Since AD&D, there hasn't been an easier version of D&D to tweak in terms of rules, although 4e made it really, really easy to swap out effects and such.
But you'll also start to find how intertwined everything is within the rules. Before you start tweaking, you really need to start to figure out what it is that bothers you about the rules. Not understanding AC and hp is one thing, but doesn't really point you toward a solution.
For me, one thing that bothered me about 5e (and this is fairly consistent across all editions), is that crucial scenes don't work within the rules. For example, in the first two adventures released for 5e, there are NPCs that ask the PCs for help because they are too injured to do it themselves. OK, why don't we just heal them? Problem solved. Other things include stuff like combat fatigue, the effects of wounds on your ability to fight, the effects of pain, etc.
I always look to see if there is really a need to change it first. For example, when 5e first came out, I hated the idea of the characters healing fully during a long rest. So I looked at alternatives. In AD&D it was 1 hp per day of rest for up to 7 days, after which you'd subtract a CON penalty if any. Starting in the second week you add your CON bonus if any to the 1 hp. Note that's per
day of rest, not a long rest.
But the game is geared towards faster healing now, to keep things moving. So I then looked at allowing them to regain 1/2 their hit points during a long rest. And what did that achieve? It basically meant that after the first day, their new maximum hit points was half of what it used to be. In other words, whatever amount you set, that's the amount that they have to assume they have on any given day. In which case it's just figuring out what you think is reasonable, and I ended up back with not changing anything.
Because it wasn't really the fact that they were healing their hit points every day. It was because they never suffered any long term effects, because they never suffered anything other than being "uninjured" and dying. So instead I started looking at how to impact their ability to act, over different periods of time. One encounter, a few hours, a day, and multiple days. All use the same exhaustion track. Combat fatigue might kick in when you're below 50% max hit points. You make a save each round, or suffer the effects. You can't die, but you can suffer fatigue. Combat fatigue lasts until the end of the combat. Fatigue you have to rest for at least 15 minutes to regain a level. If you suffer enough fatigue, you are exhausted, which works more or less as written.
So there are tons of options. You just have to figure out what you and your players are really looking for.
