Oh, I dunno - there's a few where it takes a rather distant back seat...The point is not that realism is not present in RPGs
Maybe not so much "conducive of skilled play", as that's not really the point in this case. I'd like to think, perhaps naively, that internal logic helps players make decisions and take actions consistent with what the setting expects and its internal physics can handle, while at the same time helping me-as-DM present that setting in a consistent and halfway-logical manner.The actual "good" or "value" is not so much "realism," but with how the players engage with the environment (or game) as part of cultivating the desired play experience. Based upon past conversations, I suspect that for the "Old School play" of Bedrockgames and Lanefan, the point is not "realism," but, instead, in having "known knowns" that help players make informed decisions conducive of skilled play.
I'm not sure here. "It's the same as reality unless something says it isn't" is a perfectly good and simple foundation to start from.(If I am mistaken in summarizing their preferences here, I will gladly admit my error and welcome clarification.) This is also why I find appeals to "realism" in a system to be a smokescreen that masks the actual underlying issues of the desired game play. It would be easier to identify, design, and cultivate for that desired play experience without hiding it behind vague and prejudiciously applied notions of "realism" obscuring that process.
Oddly enough, healing is one instance where realism is anything but a red herring. Natural healing and recovery is something we've all directly experienced at some point and that works at a more-or-less consistent rate in real life; and this then becomes a familiar baseline for where one wants to scale it in the game system. "More realistic" implies something closer to this baseline, "less realistic" implies something farther away e.g. in D&D 4e and 5e healing rates are a long way from realistic while 1e by RAW is much closer; no system will ever get it bang on and - given the various oddities and assumptions of the nigh-universal hit point system - is likely well advised not to try.So, again, for example if we take the matter of healing. To me its inclusion as part of a game is not a matter of "realism," but, rather, of pacing and tone. We advocate different types of healing mechanics because we want different things out of the game experience rather than "realism." If we want something "Grim 'n' Gritty" where we want to emphasize character attrition, resource management, or the dangerous, survivalist tone of the imaginative play space, then we may desire to make healing slower or more difficult to come by. But it would be far more difficult to discuss how we would potentially design healing in such a game if it is obscured behind appeals to "realism." "Realism" almost becomes a red herring in the discussion.
Another example: one approach to hit points that generally adds some realism at cost of some extra effort is any sort of wound-vitality or body-fatigue system. Wound/body points are actual physical injury, to which we can if desired then apply real-world healing rates or some approximation; while vitality/fatigue points are just that and thus can be recovered fairly quickly.