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Income Taxes (Details 2)
12 Months Ended
Dec. 31, 2013
Dec. 31, 2012
Dec. 31, 2011
Effective tax rate reconciliation      
Statutory U.S. federal tax rate 35.00% 35.00% 35.00%
Increase (decrease) in rate resulting from:      
Effect of qualified domestic production deduction (0.40%) (0.80%) (1.60%)
Effect of Patient Protection and Affordable Care Act 0.90% (0.60%)   
Effect of noncontrolling interest (1.30%) 1.10% (0.40%)
State and local income taxes, net of related federal taxes 2.00% 3.00% 2.70%
Other, net (0.20%) (0.60%) (1.20%)
Effective tax rate 36.00% 37.10% 34.50%