Consolidated Statements of Cash Flows - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Cash flows from operating activities:
Net income	$ 4,389	$ 2,743	$ 3,432
Increase (decrease) in cash from operating assets and liabilities:
Accounts receivable	(423)	(601)	10
Inventories and other assets	(242)	(69)	(112)
Accounts payable and accrued expenses	698	374	144
Depreciation and amortization	2,278	2,131	1,966
Income taxes	74	433	123
Gains on sales of facilities	(428)	(8)	(23)
Losses on retirement of debt	9	39	4
Legal claim benefits			(246)
Amortization of debt issuance costs	31	31	34
Share-based compensation	268	270	251
Other	107	83	70
Net cash provided by (used in) operating activities	6,761	5,426	5,653
Cash flows from investing activities:
Purchase of property and equipment	(3,573)	(3,015)	(2,760)
Acquisition of hospitals and health care entities	(1,253)	(1,212)	(576)
Disposal of hospitals and health care entities	808	25	26
Change in investments	57	(73)	64
Other	60	(4)	6
Net cash used in investing activities	(3,901)	(4,279)	(3,240)
Cash flows from financing activities:
Issuances of long-term debt	2,000	1,502	5,400
Net change in revolving bank credit facilities	(640)	760	(110)
Repayment of long-term debt	(1,704)	(753)	(4,475)
Distributions to noncontrolling interests	(441)	(448)	(434)
Payment of debt issuance costs	(25)	(26)	(40)
Payment of cash dividends	(487)
Repurchases of common stock	(1,530)	(2,051)	(2,751)
Other	(248)	(45)	(98)
Net cash (used in) provided by financing activities	(3,075)	(1,061)	(2,508)
Effect on exchange rate changes in cash and cash equivalents	(15)
Change in cash and cash equivalents	(230)	86	(95)
Cash and cash equivalents at beginning of period	732	646	741
Cash and cash equivalents at end of period	502	732	646
Interest payments	1,744	1,700	1,666
Income tax payments, net	$ 872	$ 1,205	$ 1,255