I live in San Francisco, and Comcast's DOCSIS 3.1 offering (~1Gbps down / 25Gbps up) is my only useful option. AT&T offers DSL, and MonkeyBrains will give me a microwave link (more or less symmetric, but probably would top out at around 100Mbps), but that's it, aside from the LTE/5G providers.

I live one block away from one of the main fiber trunks in the city, but I was quoted (both by Comcast and AT&T) that it would be $20k-$30k to run that fiber to my building.

Unfortunately I think my experience is pretty common in the US, though sure, there are plenty of people who can choose between e.g. cable and fiber.