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The author argues that there is an absence of political reflection of the French health system, which operates without fundamental organizational concepts. This results in a system with additional costs and malfunctioning practices. Geriatrics has become a specialized service that has jettisoned the promise of individual and social care. The author suggests a local approach whereby expertise and on-the-ground knowledge by geriatricians could be mobilized to adapt the system to local needs. Such a paradigm shift could decrease costs as well as being advantageous for patients.