CONSOLIDATED STATEMENTS OF CASH FLOW (USD $) In Thousands, unless otherwise specified	12 Months Ended
	Dec. 31, 2013	Dec. 31, 2012	Dec. 31, 2011
Cash flows from operating activities:
Net income	$ 757,201	$ 641,237	$ 573,395
Adjustments to reconcile net income to cash provided by operating activities:
Loss contingency reserve	397,000	85,837
Depreciation and amortization	528,119	343,908	267,315
Stock-based compensation expense	59,998	45,384	48,718
Tax benefits from stock award exercises	46,898	88,964	38,199
Excess tax benefits from stock award exercises	(36,197)	(62,036)	(20,834)
Deferred income taxes	(25,380)	43,765	53,438
Equity investment income, net	2,872	3,384	354
Other non-cash charges and loss on disposal of assets	(31,351)	30,390	20,329
Goodwill impairment charge	0	0	24,000
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures:
Accounts receivable	(59,640)	(47,673)	(88,848)
Inventories	(8,971)	4,052	10,270
Other receivables and other current assets	(108,434)	51,730	53,697
Other long-term assets	17,731	(1,775)	2,039
Accounts payable	16,666	40,878	84,400
Accrued compensation and benefits	38,368	18,476	77,074
Other current liabilities	78,817	11,083	(51,979)
Income taxes	33,499	(129,948)	77,418
Other long-term liabilities	66,145	19,029	11,061
Net cash provided by operating activities	1,773,341	1,100,848	1,180,046
Cash flows from investing activities:
Additions of property and equipment, net	(617,597)	(550,146)	(400,156)
Acquisitions	(310,394)	(4,294,077)	(1,077,442)
Proceeds from asset sales	62,258	3,559	75,183
Purchase of investments available-for-sale	(12,445)	(3,935)	(5,971)
Purchase of investments held-to-maturity	(1,039)	(7,418)	(37,628)
Proceeds from sale of investments available-for-sale	4,158	7,211	1,149
Proceeds from maturities of investments held-to-maturity	1,376	14,530	47,695
Purchase of equity investments and other assets	(3,696)	(2,182)	(2,398)
Distributions received on equity investments	497	8	340
Net cash provided by (used in) by investing activities	(876,882)	(4,832,450)	(1,399,228)
Cash flows from financing activities:
Borrowings	66,286,097	43,248,175	36,395,105
Payments on long-term debt, contingent earn-out obligations and other financing costs	(66,724,104)	(39,343,268)	(36,267,445)
Purchase of treasury stock			(323,348)
Distributions to noncontrolling interests	(139,326)	(113,504)	(100,653)
Stock award exercises and other share issuances, net	16,423	6,647	11,316
Excess tax benefits from stock award exercises	36,197	62,036	20,834
Contributions from noncontrolling interests	36,996	37,395	21,010
Proceeds from sales of additional noncontrolling interests	8,295	1,664	9,687
Purchases from noncontrolling interests	(3,569)	(26,761)	(13,689)
Net cash provided by (used in) financing activities	(482,991)	3,872,384	(247,183)
Effect of exchange rate changes on cash and cash equivalents	(967)	(786)
Net increase (decrease) in cash and cash equivalents	412,501	139,996	(466,365)
Cash and cash equivalents at beginning of the year	533,748	393,752	860,117
Cash and cash equivalents at end of the year	$ 946,249	$ 533,748	$ 393,752