Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
Cash Flows from Operating Activities:
Net income	$ 400,964	$ 478,663
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	250,602	241,208
Loss on sale of assets and businesses	2,161
Stock-based compensation expense	33,954	34,676
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	131,294	(101,329)
Accrued interest	(2,191)	948
Accrued and deferred income taxes	116,707	(16,846)
Other working capital accounts	26,361	30,082
Medicare accelerated payments and deferred governmental stimulus grants	477,099
Other assets and deferred charges	5,095	(1,333)
Other	(7,659)	(1,209)
Accrued insurance expense, net of commercial premiums paid	81,016	51,819
Payments made in settlement of self-insurance claims	(64,034)	(44,115)
Net cash provided by operating activities	1,451,369	672,564
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(354,610)	(323,920)
Proceeds received from sales of assets and businesses	6,440
Acquisition of businesses and property	(968)
Inflows from foreign exchange contracts that hedge our net U.K. investment	57,029	4,885
Costs incurred for purchase and implementation of information technology applications	(4,421)	(13,893)
Investment in, and advances to, joint ventures and other	(285)	(11,949)
Net cash used in investing activities	(296,815)	(344,877)
Cash Flows from Financing Activities:
Reduction of long-term debt	(459,332)	(28,617)
Additional borrowings	5,453	177,200
Repurchase of common shares	(200,054)	(494,649)
Dividends paid	(17,344)	(17,953)
Issuance of common stock	5,852	5,271
Profit distributions to noncontrolling interests	(8,885)	(11,650)
Net cash used in financing activities	(674,310)	(370,398)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(1,639)	(273)
Increase (decrease) in cash, cash equivalents and restricted cash	478,605	(42,984)
Cash, cash equivalents and restricted cash, beginning of period	105,667	199,685
Cash, cash equivalents and restricted cash, end of period	584,272	156,701
Supplemental Disclosures of Cash Flow Information:
Interest paid	61,802	78,623
Income taxes paid, net of refunds	14,394	145,404
Noncash purchases of property and equipment	80,031	71,923
Right-of-use assets obtained in exchange for lease obligations	$ 37,780	$ 359,329