My experience of different game systems is far less than yours. Can you think of a game system that plies the middle ground in this regard? How does it work?
I'm having trouble thinking of one. However, let's look at Rolemaster for a moment:
There are basically two types of wound in Rolemaster. You have your general "concussive hits" which fulfill the role of hit points in D&D. If you manage to lose all of them, you die. Until then, your combat effectiveness isn't impaired - that's if I remember correctly, for it has been quite a while since I've played Rolemaster.
However, more significant than CP are Critical Hits, which provide actual descriptions of the wounds you suffer. It's been observed that hitting people doesn't kill people in RM, crits kill people. It's an observation I agree with. So, you can get a "thigh wound" which reduces your movement by 25% until healed - either through rest or curative magic.
In RM, combat is a bit too deadly for my liking, and it certainly has the death spiral effect, where hits impair your abilities so much that you can't come back.
Iron Heroes used Reserve Points - basically an additional reservoir of hit points that refilled your HP between encounters. They fulfill exactly the same function of healing surges.
Damage in the Amber DRP game was entirely narrative - with no dice, it was pretty much all storytelling, and you quickly got a handle on how much the GM liked your character or not.
In Star Wars d6, you had wound levels - either you were Unwounded, Lightly Wounded, Heavily Wounded, Incapacitated or Dead. Each would reduce your abilities, and healing was a pain. However, you tended not to be wounded that much, IIRC. Boy, it's been a while since I played it and my memory is fuzzy - and I played it for four years pretty solidly.
James Bond 007 (one of my favourite games) had a similar system, and you used Hero Points to avoid wounds altogether. First Aid could reduce the severity of some wounds, but mostly you needed to go to hospital if you were badly hurt.
In most of those systems, the effects of damage were pretty severe. The main point was that you needed to avoid being hit in the first place, and they'd give mechanisms to allow to you to do that: Hero Points in James Bond, really high Dodge scores and Force Points in Star Wars. If you got hit, you were actually hit.
D&D has a simpler system where the mechanism for avoiding being hit is also part of the hit point system. If you get "hit" for 40 hp - enough damage to kill a horse - and you still have 40 hp, then we say you weren't actually hit after all. Healing Surges are indeed confusing the issue, and the books don't actually provide guidance on how to handle the issue for those wanting a more narrative/simulated experience.
Cheers!