Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Cash Flows from Operating Activities:
Net income	$ 560,152	$ 331,677
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	288,483	285,365
Gain on sale of assets and businesses	(3,725)	(6,250)
Stock-based compensation expense	46,162	43,062
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	66,174	(82,078)
Accrued interest	3,310	(107)
Accrued and deferred income taxes	26,970	(32,695)
Other working capital accounts	39,686	20,216
Medicare accelerated payments and deferred CARES Act and other grants		2,741
Other assets and deferred charges	(3,030)	32,746
Other	14,277	15,471
Accrued insurance expense, net of commercial premiums paid	102,222	95,157
Payments made in settlement of self-insurance claims	(64,994)	(51,604)
Net cash provided by operating activities	1,075,687	653,701
Cash Flows from Investing Activities:
Property and equipment additions	(449,933)	(336,664)
Proceeds received from sales of assets and businesses	5,428	23,688
Acquisition of businesses and property		(3,728)
Inflows (outflows) from foreign exchange contracts that hedge our net U.K. investment	6,830	(31,305)
Decrease in capital reserves of commercial insurance subsidiary	196
Net cash used in investing activities	(437,479)	(348,009)
Cash Flows from Financing Activities:
Repayments of long-term debt	(382,675)	(93,557)
Additional borrowings, net	12,038	0
Financing costs		(293)
Repurchase of common shares	(237,987)	(209,756)
Dividends paid	(27,006)	(28,263)
Issuance of common stock	7,227	6,598
Profit distributions to noncontrolling interests	(5,089)	(4,735)
Sale of ownership interests to minority members	5,025	407
Net cash used in financing activities	(628,467)	(329,599)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(392)	2,377
Increase (decrease) in cash, cash equivalents and restricted cash	9,349	(21,530)
Cash, cash equivalents and restricted cash, beginning of period	214,470	200,837
Cash, cash equivalents and restricted cash, end of period	223,819	179,307
Supplemental Disclosures of Cash Flow Information:
Interest paid	95,902	97,297
Income taxes paid, net of refunds	131,499	133,840
Noncash purchases of property and equipment	$ 108,260	$ 100,461