Just read Mankiw’s new paper and this occurred to me:
I’m definitely a jerk if I don’t have other’s outcomes in my utility function. I’m a paternalist if I have other people’s consumption in my utility function, not their utility.
This is why a paternalist can give you healthcare instead of cash because your consumption of healthcare matters to him more than your happiness/contentedness/life satisfaction/etc.
Interestingly, most folks are jerks with respect to foreigners, they’re paternalist with respect to other anonymous citizens and they’re neither with respect to their close friends and family. I can’t find reason in this mix of preferences.