I couldn't live without Sirius. I also have an iPod adapter.
Depending on your sound system, the quality difference between say, FM radio or a CD and Sirius will be more noticable. No, it's not the greatest sound quality, because it is compressed, but some stations are better than others (less compressed) and I am used to it now. The sound quality is a non-issue for me.
The ability to listen to so many different types of music, without commercials, is awesome. I have really expanded my own music library with Sirius. My iPod has a lot of stuff on it now that it wouldn't have otherwise had. There is just so much stuff you can't get on regular radio or searching for good music otherwise. I just love Sirius.
The fee doesn't bother me at all, I pay for a whole year in advance so at $142, that is about the same as one month of my cable/internet bill. No big deal.
I would not go without Sirius in my daily driver. I am totally hooked. The product is great, customer service just SO-SO. As I needed a refund for Sirius on a car that I had sold, and it took them 2 months to process it.
If you like music, you won't be disappointed.