Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2022	Jun. 30, 2021
Cash Flows from Operating Activities:
Net income	$ 309,802	$ 534,346
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation & amortization	287,634	265,388
(Gain) loss on sale of assets and businesses	1,084	(4,803)
Stock-based compensation expense	41,640	37,031
Provision for asset impairment		7,195
Changes in assets & liabilities, net of effects from acquisitions and dispositions:
Accounts receivable	(89,729)	(35,903)
Accrued interest	1,329	(1,459)
Accrued and deferred income taxes	(34,260)	(26,769)
Other working capital accounts	(98,811)	3,560
Medicare accelerated payments and deferred CARES Act and other grants	5,339	(697,011)
Other assets and deferred charges	30,278	(28,763)
Other	(15,763)	5,052
Accrued insurance expense, net of commercial premiums paid	97,570	104,079
Payments made in settlement of self-insurance claims	(58,066)	(42,495)
Net cash provided by operating activities	478,047	119,448
Cash Flows from Investing Activities:
Property and equipment additions	(407,962)	(482,211)
Proceeds received from sales of assets and businesses	10,232	21,143
Acquisition of businesses and property	(12,485)
Inflows (outflows) from foreign exchange contracts that hedge our net U.K. investment	84,535	(21,487)
Decrease in capital reserves of commercial insurance subsidiary	100	100
Costs incurred for purchase of information technology applications, net of refunds		(1,246)
Net cash used in investing activities	(325,580)	(483,701)
Cash Flows from Financing Activities:
Repayments of long-term debt	(226,854)	(278,785)
Additional borrowings, net	700,000	6,578
Financing costs	(2,387)
Repurchase of common shares	(565,182)	(368,080)
Dividends paid	(29,641)	(33,844)
Issuance of common stock	6,661	6,442
Profit distributions to noncontrolling interests	(5,323)	(5,617)
Purchase (sale) of ownership interests by (from) minority members	(1,307)	11,433
Net cash used in financing activities	(124,033)	(661,873)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	(5,457)	660
Increase (decrease) in cash, cash equivalents and restricted cash	22,977	(1,025,466)
Cash, cash equivalents and restricted cash, beginning of period	178,934	1,279,154
Cash, cash equivalents and restricted cash, end of period	201,911	253,688
Supplemental Disclosures of Cash Flow Information:
Interest paid	43,796	43,641
Income taxes paid, net of refunds	145,448	189,979
Noncash purchases of property and equipment	$ 112,420	$ 95,979