Bitcoin exchanges exist because the US dollar and other currencies (still) exist.
Bitcoin was not designed with the goal of securely converting between BTC and USD.
Bitcoin was designed with the goal of securely allowing "online payments [in BTC] to be sent directly from one party to another without going through a financial institution".
To answer your question, you would use Bitcoin when you want your payments to go directly to the recipient, without going through banks and taking days or weeks to confirm. You would also use it when you want a certain degree of pseudonymity. You might even use it to make a political statement: "I don't like the US Federal Reserve, so I'll just buy everything in Bitcoin now."
I agree with you that exchanges can be a problem, so until we get rid of all the other extra currencies (hehe), acquiring some initial amount of BTC will be a little problematic.