> Exposure to pressure below this limit results in a rapid loss of consciousness, followed by a series of changes to cardiovascular and neurological functions, and eventually death, unless pressure is restored within 60–90 seconds.
I'd say that altitude is the reason for the focus on long distance.
So I suspect only long flights will be operated that high, and there will be some calculation for the optimal altitude for shorter flights.
Another issue is the survivability of incidents. If something goes wrong, for example with your pressure cabin or your oxygen supply, you have only seconds to start your mitigation measures.
https://theconversation.com/air-travel-exposes-you-to-radiat...