And then there are people like me, who do not live in a bustling heart of a metropolis. The telephone company was very iffy about getting even the ISDN for me, and definitely negative about anything wider. It is over five kilometers from my house to the closest multiplexer -- it is not exactly a "last mile" any more.
 
There are parts of the US where the local RBOC (regional phone company split off from the old monopoly) is required to offer ISDN but can get away with making it prohibitively expensive (more than the cost of a T1 unless you're using it less than thirty or so minutes per day) because they really don't want to sell ISDN service. (In other parts of the country ISDN is a quite reasonable medium to use, I've heard.)

I've got no idea how recent competitors to the RBOCs price ISDN.

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