They are playing with cheap and powerful technology and Internet-mediated talent and capital.

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Talent--combined with technology and political will--can make difference.

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In our world-is-flat, winner-take-all economy, many futurists said the winners would fall into two camps: super nimble start-ups from Silicon Valley (and similar hotbeds) wielding world-class technology and talent and the largest multinationals with brand, reach and fortress balance sheets.

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Now these aging and sometimes decrepit institutions are in need of new talent and technology, and they lack the financial leverage to cope with malpractice and other costs that are rising faster than government reimbursements.

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San Diego is the base for companies like Qualcomm that make the underlying technology for wireless communications, and to a number of smaller companies with demand for tech talent.

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