Totally agreed - I think especially with healthcare, cities like Cleveland, Pittsburgh and St. Louis have nationally elite medical centers (Cleveland Clinic, University of Pittsburgh and WSL, respectively) along with all the healthcare service industries that surround such centers, and therefore are able to attract and retain top talent at all levels of the healthcare industry.
Since this is HN, I guess the question is when will the developer / VC ecosystem develop, but I personally think it's just a matter of time before successful "tentpole" startups will pop up in each market, and after that when your significant other gets into a 7 year residency at WSL you don't break up because you want to do a start-up in NY/SF/SEA - you just move too and hopefully are able to bootstrap more efficiently than you would be paying $3,000 for a studio =)
Since this is HN, I guess the question is when will the developer / VC ecosystem develop, but I personally think it's just a matter of time before successful "tentpole" startups will pop up in each market, and after that when your significant other gets into a 7 year residency at WSL you don't break up because you want to do a start-up in NY/SF/SEA - you just move too and hopefully are able to bootstrap more efficiently than you would be paying $3,000 for a studio =)