I was trying to write about the comings and goings at the top of the new Patient Protection and Affordable Care Act (PPACA) public exchange programs, when the English language got me all tangled up.

The exchanges were replacing “acting” or “interim” executive directors with managers designated, in one way or another, as the “real,” “permanent executive” directors.

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PPACA is creating two “transitional” risk-management programs to try to keep PPACA changes from capsizing health insurers, and it also has a “permanent” risk-adjustment program.

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I was thinking, maybe I conjured the word “permanent,” as it pertains to the PPACA risk-adjustment program, out of thin lay brain air, but officials at the Centers for Medicare & Medicaid Services (CMS) use the word “permanent” to refer to the risk-adjustment program in a summary of regulations they posted in March 2012.

What’s hilarious about this is the illusion the word “permanent” creates in this context that anything related to PPACA is likely to last more than three years.

On the one hand, something about PPACA is bound to be extremely durable and last for a long time. Maybe the tanning salon tax will last millennia. Maybe, when Google uploads our brains into the luxury virtual reality database that will be our species’ final home, some of our virtual avatars will be making other virtual avatars pay a virtual PPACA tanning salon tax.

But, on the other hand, even if the PPACA exchange program and commercial health insurance rules perform well, the law may soon be replaced by a souped up PPACA 1.5.

If the exchanges and the product rules create a mess, or the Republicans do well in November, or both, we could get a PPACA Killer 0.1 System.

The universe is permanent. The Sun gives a convincing illusion of being permanent. U.S. health care system officials and rules might be here long enough for us to get a pretty good look at them — if the officials are lucky.

On the third hand, PPACA may well prove to leave traces that seem permanent to anyone trying to reverse PPACA changes. As Thomas Wolfe said, in a very early version of a blog entry that Douglas Elmendorf just posted on the Congressional Budget Office website, “Time Is a River,” and “You Can’t Go Home Again.”