Network neutrality probably would not be as big of an issue if ISPs in America were not quasi-monopolies. In a market with healthy competition, it seems much less likely that the only choice available would be some tiered, managed entity that throttles back "non-favored" traffic -- perhaps that option would be available at the lower end, but a "power user" market with net neutrality practices would probably exist as well.

Unfortunately, many markets are served by only one high speed ISP in the United States. This makes the net neutrality fears somewhat more realistic.

I will say that from this angle, I put quite a bit more weight on correcting other anti-competitive practices pushed into law by communications companies. Things like states banning and suing municipal broadband efforts come to mind. The American marketplace for Internet ISPs as a result is quite distorted, certainly far from an open, competitive marketplace.