In my country (NL), a lot of the backbone of both cable TV and internet on a street level has been replaced with fiber already; I can imagine that in the US, due to the scale, this process is lower. Doesn't have to be fiber-to-the-home, 20mbit should be enough for everyone for example.

I haven't had any problems with my internet (I do have fiber straight into my house, wired network on my laptop, fast.com reports 600 Mb/s), but Skype, which we use for meetings, has been pretty shit in terms of sound quality.