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Investments (Narrative) (Details)
3 Months Ended 12 Months Ended
Dec. 31, 2018
USD ($)
shares
Sep. 30, 2018
USD ($)
Jun. 30, 2018
USD ($)
Jun. 30, 2018
GBP (£)
Mar. 31, 2018
USD ($)
Dec. 31, 2017
USD ($)
shares
Sep. 30, 2017
USD ($)
Jun. 30, 2017
USD ($)
Mar. 31, 2017
USD ($)
Dec. 31, 2016
USD ($)
Dec. 31, 2018
USD ($)
shares
Dec. 31, 2017
USD ($)
shares
Dec. 31, 2016
USD ($)
Dec. 31, 2018
GBP (£)
shares
Dec. 31, 2017
GBP (£)
shares
Schedule of Investments [Line Items]                              
Money market investments $ 75,500,000         $ 217,600,000         $ 75,500,000 $ 217,600,000      
Marketable equity securities 496,390,000                   496,390,000        
Marketable equity securities           536,315,000           536,315,000      
Cash paid for new marketable equity securities                     42,700,000 0 $ 48,300,000    
Marketable equity securities purchased                         47,900,000    
Cumulative realized gain (loss) on marketable securities                     0 0 (1,791,000)    
Proceeds from sales of marketable equity securities                     66,700,000 0 29,700,000    
Loss on sales of marketable equity securities                         8,100,000    
Gain on sales of marketable equity securities                     37,300,000   6,200,000    
Equity Method Investment, Other than Temporary Impairment           2,800,000                  
Equity in earnings (losses) of affiliates, net 1,426,000 $ 9,537,000 $ 931,000   $ 2,579,000 (4,697,000) $ (532,000) $ 1,331,000 $ 649,000   14,473,000 (3,249,000) (7,937,000)    
Equity Securities without Readily Determinable Fair Value, Amount 30,600,000         $ 19,900,000         30,600,000 19,900,000      
Gains on cost method investments $ 3,200,000 8,500,000                 11,663,000 $ 0 $ 0    
Impairment loss on cost method investments                     $ 2,697,000        
Markel Corporation [Member]                              
Schedule of Investments [Line Items]                              
Number of shares held in investment | shares 28,000         28,000         28,000 28,000   28,000 28,000
Marketable equity securities $ 29,100,000                   $ 29,100,000        
Marketable equity securities           $ 31,900,000           $ 31,900,000      
Intersection [Member]                              
Schedule of Investments [Line Items]                              
Ownership percentage of investment in affiliate 11.00%                   11.00%     11.00%  
HomeHero [Member]                              
Schedule of Investments [Line Items]                              
Equity Method Investment, Other than Temporary Impairment                   $ 8,400,000          
Equity in earnings (losses) of affiliates, net   2,100,000                          
One Investment [Member]                              
Schedule of Investments [Line Items]                              
Equity in earnings (losses) of affiliates, net   $ 5,800,000                          
Graham Healthcare Group [Member]                              
Schedule of Investments [Line Items]                              
Revenue from Related Parties                     $ 12,100,000 $ 18,300,000      
Graham Healthcare Group [Member] | Residential Home Health Illinois [Member]                              
Schedule of Investments [Line Items]                              
Ownership percentage of investment in affiliate 40.00%                   40.00%     40.00%  
Graham Healthcare Group [Member] | Residential Hospice Illinois [Member]                              
Schedule of Investments [Line Items]                              
Ownership percentage of investment in affiliate 42.50%                   42.50%     42.50%  
Graham Healthcare Group [Member] | Residential And Michigan Hospital Joint Venture [Member]                              
Schedule of Investments [Line Items]                              
Ownership percentage of investment in affiliate 40.00%                   40.00%     40.00%  
Graham Healthcare Group [Member] | Celtic Healthcare Allegheny Health Network Joint Venture [Member]                              
Schedule of Investments [Line Items]                              
Ownership percentage of investment in affiliate 40.00%                   40.00%     40.00%  
KIHL [Member] | York Joint Venture [Member]                              
Schedule of Investments [Line Items]                              
Ownership percentage of investment in affiliate 45.00%                   45.00%     45.00%  
Loan commitment to affiliate | £                           £ 25,000,000  
Advances to Affiliate | £                           £ 22,000,000 £ 16,000,000
Payments to Fund Long-term Loans to Related Parties | £       £ 6,000,000                      
Loan Receivable, Payment Term 25 years                            
Loan Receivable Fixed Interest Rate 7.00%