Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Cash Flows from Operating Activities:
Net income	$ 331,677	$ 309,802
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	285,365	287,634
(Gain) loss on sale of assets and businesses	(6,250)	1,084
Stock-based compensation expense	43,062	41,640
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(82,078)	(89,729)
Accrued interest	(107)	1,329
Accrued and deferred income taxes	(32,695)	(34,260)
Other working capital accounts	20,216	(98,811)
Medicare accelerated payments and deferred CARES Act and other grants	2,741	5,339
Other assets and deferred charges	32,746	30,278
Other	15,471	(15,763)
Accrued insurance expense, net of commercial premiums paid	95,157	97,570
Payments made in settlement of self-insurance claims	(51,604)	(58,066)
Net cash provided by operating activities	653,701	478,047
Cash Flows from Investing Activities:
Property and equipment additions	(336,664)	(407,962)
Proceeds received from sales of assets and businesses	23,688	10,232
Acquisition of businesses and property	(3,728)	(12,485)
(Outflows) inflows from foreign exchange contracts that hedge our net U.K. investment	(31,305)	84,535
Decrease in capital reserves of commercial insurance subsidiary	0	100
Net cash used in investing activities	(348,009)	(325,580)
Cash Flows from Financing Activities:
Repayments of long-term debt	(93,557)	(226,854)
Additional borrowings, net	0	700,000
Financing costs	(293)	(2,387)
Repurchase of common shares	(209,756)	(565,182)
Dividends paid	(28,263)	(29,641)
Issuance of common stock	6,598	6,661
Profit distributions to noncontrolling interests	(4,735)	(5,323)
Purchase (sale) of ownership interests by (from) minority members	407	(1,307)
Net cash used in financing activities	(329,599)	(124,033)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	2,377	(5,457)
(Decrease) increase in cash, cash equivalents and restricted cash	(21,530)	22,977
Cash, cash equivalents and restricted cash, beginning of period	200,837	178,934
Cash, cash equivalents and restricted cash, end of period	179,307	201,911
Supplemental Disclosures of Cash Flow Information:
Interest paid	97,297	43,796
Income taxes paid, net of refunds	133,840	145,448
Noncash purchases of property and equipment	$ 100,461	$ 112,420