A couple reasons. First of all, most applications would want to use separate VDD for IO, since 5 V is not the most common voltage anymore. You can make such device take external regulated 3.3 V, but that again would limit VDDIO range.
And then USB is 3.3 V signalling, so you would need some voltage regulator if you use 5 V supply. This regulator would likely need an external bypass capacitor.
This is exactly what happens with Holtek HT42B534. It is available in 8-pin SOP package and two extra pins go to VDDIO and the bypass capacitor for the internal voltage regulator. This way this device can be used with system voltages 1.8-5.0 V.
The annoying part with those devices is that they are not standard CDC ACM class, so they need proprietary drivers.