HSA gets you the negotiated rate, you just pay the negotiated rate yourself. It's really the best of both worlds.
If fails if you have an ongoing condition which costs (at negotiated rates enough that the difference in premiums between a PPO and an HSA is less than the deductible for the HSA. Personally, I don't think charging $100-200/mo in premium and expecting to pay out $500-1000/mo in existing care from day one, plus the possibility of higher costs for new conditions down the line, is a viable proposition for a private insurer. That should be paid by individuals themselves or by government (as a direct subsidy), but it's not insurance.
If fails if you have an ongoing condition which costs (at negotiated rates enough that the difference in premiums between a PPO and an HSA is less than the deductible for the HSA. Personally, I don't think charging $100-200/mo in premium and expecting to pay out $500-1000/mo in existing care from day one, plus the possibility of higher costs for new conditions down the line, is a viable proposition for a private insurer. That should be paid by individuals themselves or by government (as a direct subsidy), but it's not insurance.