The basic reason is because we don't use passwords.
We always use public/private certificates on all of our machines.
With PAM you have to use passwords. We'll release a version soon that works with PAM, but I recommend you switch to using authorized_keys with certificates. Not only is it much more secure, it's also much nicer to use.
I do use authorized_keys, though PAM is good for a lot more than just sshd; that's why I say it is more flexible. For example, I could see two factor authentication being used to log into shared workstations through XDM/GDM. This would eliminate the possibility that your users are sharing passwords for their accounts.
Also, the way I would intend on using this is such that if your public key is in authorized_keys, you log in like normal. If not, you authenticate with PAM using both your unix password (or ldap or whatever you have configured) and your 2nd authentication system. I log into one or two of my servers from strange computers often enough that disabling password authentication entirely on those servers is limiting.
Yeah we'll release a PAM module soon so you can do this. If you don't want to wait, you could write one. Just look at this module, it's fairly simple. The API is really straight forward.