Condensed Consolidated Statements of Cash Flows - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2018	Sep. 30, 2017
Cash flows from operating activities:
Net income	$ 3,144	$ 2,102
Increase (decrease) in cash from operating assets and liabilities:
Accounts receivable	(161)	(70)
Inventories and other assets	(136)	(50)
Accounts payable and accrued expenses	150	(169)
Depreciation and amortization	1,697	1,581
Income taxes		(9)
Gain on sales of facilities	(420)	(10)
Losses on retirement of debt	9	39
Amortization of debt issuance costs	23	23
Share-based compensation	204	195
Other	76	60
Net cash provided by (used in) operating activities	4,586	3,692
Cash flows from investing activities:
Purchase of property and equipment	(2,420)	(2,033)
Acquisition of hospitals and health care entities	(1,056)	(1,142)
Disposal of hospitals and health care entities	802	24
Change in investments	65	(15)
Other	(6)	(6)
Net cash used in investing activities	(2,615)	(3,172)
Cash flows from financing activities:
Issuances of long-term debt	2,000	1,502
Net change in revolving bank credit facilities	(330)	650
Repayment of long-term debt	(1,652)	(700)
Distributions to noncontrolling interests	(315)	(363)
Payment of debt issuance costs	(24)	(25)
Payment of cash dividends	(366)
Repurchases of common stock	(1,195)	(1,475)
Other	(232)	(37)
Net cash (used in) provided by financing activities	(2,114)	(448)
Effect of exchange rate changes on cash and cash equivalents	(11)
Change in cash and cash equivalents	(154)	72
Cash and cash equivalents at beginning of period	732	646
Cash and cash equivalents at end of period	578	718
Interest payments	1,422	1,383
Income tax payments, net	$ 702	$ 911