Equal temperament messes with that a little but its still approximately there.
So why should simple ratios sound good? From what I've read, its probably overtones, and the way overtones excite the cilia in our inner ear. If you plot the overtones from the two notes of an octave or a fifth, they co-incide a lot.
And then why the pattern of notes on the piano keyboard? (More precisely 'why does the major scale use those 7 semitones?') ... I think with that scale, and the other scales, its something to do with squeezing the most amount of 'relationships' possible from a subset of notes without muddying the waters by having too many in play. Music is all about patterns and a mix of repetition and progression, and so having a finite number of notes that have intersting relationships with each other gives a good canvas to work with.
(Any why 12 semitones? Again, to do with getting the most interesting relationships without muddying things ... I think its possible to divide the octave into 19 or 43 parts and get some interesting ratios/relationships, but then it gets quite fiddly)