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I spoke with someone that claimed to have been a 4e play tester and here is a recap of what he said.

Prior to release, while they were play testing 4e, hit points and healing surges had a bit more complexity.

The Bloodied condition has the name bloodied for a reason. During play testing bloodied is the point that you're now taking lasting physical damage that can't just be banished with a brief rest..

While play testing, their mechanism worked like so.
All damage above bloodied was fatigue and quick recoverable damage.
All healing surges worked to cure hit points only for those "fatigue" parts of the hit point total.

All the damage beyond bloodied was unhealable by healing surges.

So if you had 50 hit points and took 25, and then used a surge, you'd potentially be able through rest for a short period to get full recovery.

But, if you took more than your bloodied amount, you noted how many past bloodied you took. Those could not be recovered by healing surges, only by magic or natural healing.

Mind you, when asked why WotC didn't keep it, they responded that designers intended it to be used by young kids and that this was "too complex for young kids"

If this is true, then that right there is the mechanism that should be used in here. If healing surges are to stay, this methodology for hit points and damage is a fine compromise.

It keeps healing surges as part of the game, letting you recover hit points lost due to fatigue, but still creating a method to create lasting damage that requires more than 6 hours of healing.

It'd also explain the reason why "bloodied" is called what it is.

Orcus wrote:

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When I first read that, I said "wow that is great! I am totally proposing that as an alternate rule!" (and I still might). But then I got to thinking... I dont think much. So bear with me. Its a bit painful...

What does that really mean, "magical healing"? Do you mean potions? Even potions use healing surges. Do you mean divine clerical magic? Because they use healing surges too. So when exactly would you not get to use healing surges? If you are bloodied? Well, ok then. What mechanism would you use for healing? Just rest? THAT is just as counter to the history of D&D as healing surges are. There has never been a rule that you can only heal 1/2 your hp and the rest has to be by sleep and R&R. If you say, healing surges by magical or divine means is fine, well then that is basically a meaningless restriction since Healing Word is an encounter power (more than that actually) so a cleric could cast 1 of those every 5 minutes. Which, actually, is more than in AD&D. So I'm not sure that is a real restriction.

But then maybe I am not understanding your rule.

Well, I am only relating what I was told. I didn't go into it with the person to any great detail of asking "what about this condition" or "what about that condition". Perhaps I should have. But here's the thing, if you look back at the history of the game, clerical magic has historically been the primary method of physical healing. Sure there have been sorcerous methods of healing available to magic users, but in general those methods are vampiric in nature rather then genuine healing. Meanwhile clerical magic has had things like regeneration and resurection that can restore even lost limbs and organs... genuine physical healing.

Now, that said, if you're asking me what I'd suggest...well, your own reaction is pretty telling. You liked the premise right off the bat. So let's play with the idea and see if it's workable. I'm going to throw out some ideas about how it could be a workable system, and let's see how things might play out with such suggestions.

I'd say that since "Bloodied" is static in definition, in terms of a percentile of hit point total, just carry it out to it's logical conclusion.

Divide hit points in half. 50% are your fatigue, 50% are your physical with any left over slotted into physical hit point total or fatigue as the player wishes. If you exceed your fatigue total, you start knocking points off your physical total.

As far as healing goes, normal, natural daily healing surges only cure fatigue damage, period. Natural recovery requires a night's rest and food and water. If you can get a good 6-8 hours or solid rest, once per day you can recover some percentage of your total hit points back. (not just a number of hit points a percentage, thus letting healing use the same amount of time regardless of level.

As far as clerical healing goes that uses healing surges, all actual healing is equally divided between physical and fatigue, and for powers that can be used more or less at will, the max physical that can be healed per day is 50% of the max of that power times the level of the caster. After that point they can no longer heal more with THAT specific power.

As for sorcerous healing, all healing that uses healing surges is simply the same as natural healing surges, you're simply getting more of them

As for potions, clerical potions do the same as clerical healing, and sorcerous potions do 75% fatigue and 25% physical (giving mages and their ilk a partial back door to getting some physical healing done)

My thoughts on it were that clerical magic and other magics are distinctly separate, just like they were in 1st edition. Genuine physical healing only comes naturally, or through the intervention of the deities. So potions that are clerical in nature can cure actual physical damage as well as restoring fatigue, while a potion created by a mage .

So, let's run some theoreticals.

A character has 100 hit points and takes 50 points in an encounter, entering bloodied territory. The character spends a healing surge, healing 25 hit points, he is now at 75 hit points. None of the damage preciously taken was more than superficial bumps, bruises and knicks. They take another short rest and he spends another surge, taking him back to 100%. He's adjusted armor, bandaged up any small knicks, applying some honey to the wounds, and all is cool.

Okay, that's best case for the player.

Now, Case 2.
Same character, only in this one he's taken 60 hit points, ten points more than his bloodied condition, and therefore takes 10 points of lasting physical damage, which limits how much he can heal via surges. He spends a surge, getting 25 back, he's at 65 hit points total, but his max limit is 90 hit points, and will continue to be that till he heals it naturally or through magical healing. So he spends another healing surge, which will take him to 90 hit points. Spending another surge would at this point do nothing. But he has a cleric in the party who can heal him... the cleric heals him, splitting the total healing between physical and fatigue...with any extra fatigue healed being lost.... so maybe it would have been better for the character to have not spent that extra healing surge just before that was done.

If it were me... I'd say just run two seperate "hit point" totals. One purely physical hit points, that is more difficult to heal, one purely fatigue based, and easy to heal.

To draw an anaology, think of the hit point values to be tracked sort of like magic points in Call of Cthulhu, you track a Max value, and a current value.

Sure there'd have to be a few rules additions, but it's not like we're talking rocket science here. You're already having to track Bloodied and the value of your surges in the first place, so adding a single layer of overhead wouldn't be all THAT tricky.

An nice feature of this sort of system is the potential to insert some variety into the mix.

Magical potions made by clerics could be great for healing physical damage, but magical potions made by magic users would be better for fatigue recovery.

So a clerical potion used on a person who has only taken fatigue damage would get less healing (losing the physical healing part of it's properties) than a person who took a magically created one. And a person who has taken mostly fatigue could chug a magical healing potion and not have to spend a healing surge to recover through rest.

There's lots of potential here in my opinion, it'd just need to be fleshed out and you'd have a fine compromise for both old and new. My opinion however is that rather than a 50/50 split I'd go more for a 75/25 split. That way natural healing surges would have more practical impact. But that's just me.