I used to live in a city with about 80,000 people. My choices were cruddy comcast service or slower DSL. Netflix was always buffering.
I moved into the countryside about 10 miles out of town. Comcast doesn't provide service here but there is a small regional cable company. As a result, my service 2-3x faster, and costs 60% of what I used to pay Comcast.
The real issue is that cable companies are not considered common carriers. In the UK they do the common carrier thing and there is massive competition, better service, cheaper prices: http://www.npr.org/blogs/money...
Now, about that "US is so big" bullshit. The US is like half a dozen regional Japans or Frances or Sweedens. In the middle of nowhere WY -- yeah, you aren't going to have fiber. But what about the I-5 corridor from Portland to Seattle? That's densely populated. Or WA DC to NY City -- that's major density. No reason you couldn't have 10x the speed at 1/10th the cost in any of those types of places.