CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2015	Dec. 31, 2014	Dec. 31, 2013
Cash flows from operating activities:
Net income	$ 427,410	$ 863,330	$ 757,201
Adjustments to reconcile net income to cash provided by operating activities:
Settlement charge and loss contingency accrual	495,000	17,000	397,000
Depreciation and amortization	638,024	590,935	528,119
Goodwill and other intangible asset impairment charges	210,234
Debt redemption and refinancing charges	48,072	97,548
Stock-based compensation expense	56,664	56,743	59,998
Tax benefits from stock award exercises	45,749	59,119	46,898
Excess tax benefits from stock award exercises	(28,157)	(45,271)	(36,197)
Deferred income taxes	61,744	210,955	(25,380)
Equity investment income, net	9,293	10,125	2,872
Other non-cash charges	44,691	39,274	(31,351)
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures:
Accounts receivable	(202,867)	(40,676)	(59,640)
Inventories	(48,313)	(46,398)	(8,971)
Other receivables and other current assets	32,761	(61,674)	(108,434)
Other long-term assets	3,723	2,916	17,731
Accounts payable	30,998	(2,956)	16,666
Accrued compensation and benefits	54,950	97,261	38,368
Other current liabilities	113,470	83,590	78,817
Settlement payments	(493,775)	(410,356)
Income taxes	24,175	(60,475)	33,499
Other long-term liabilities	33,354	(1,583)	66,145
Net cash provided by operating activities	1,557,200	1,459,407	1,773,341
Cash flows from investing activities:
Additions of property and equipment	(707,998)	(641,330)	(617,597)
Acquisitions	(96,469)	(272,094)	(310,394)
Proceeds from asset and business sales	19,715	8,791	62,258
Purchase of investments available-for-sale	(8,783)	(8,440)	(12,445)
Purchase of investments held-to-maturity	(1,709,883)	(472,628)	(1,039)
Proceeds from sale of investments available-for-sale	2,058	2,475	4,158
Proceeds from investments held-to-maturity	1,637,358	141,072	1,376
Purchase of intangible assets		(1,018)	(2,391)
Purchase of equity investments	(17,911)	(35,382)	(1,305)
Distributions received on equity investments	129	825	497
Net cash used in investing activities	(881,784)	(1,277,729)	(876,882)
Cash flows from financing activities:
Borrowings	54,541,988	60,038,508	66,286,097
Payments on long-term debt and other financing costs	(53,922,290)	(60,046,487)	(66,723,385)
Deferred financing and debt redemption and refinancing costs	(76,672)	(122,988)	(719)
Purchase of treasury stock	(549,935)
Distributions to noncontrolling interests	(174,635)	(149,339)	(139,326)
Stock award exercises and other share issuances, net	26,155	19,500	16,423
Excess tax benefits from stock award exercises	28,157	45,271	36,197
Contributions from noncontrolling interests	54,644	64,655	36,996
Proceeds from sales of additional noncontrolling interests		3,777	8,295
Purchases of noncontrolling interests	(66,382)	(17,876)	(3,569)
Net cash used in financing activities	(138,970)	(164,979)	(482,991)
Effect of exchange rate changes on cash and cash equivalents	(2,571)	2,293	(967)
Net increase in cash and cash equivalents	533,875	18,992	412,501
Cash and cash equivalents at beginning of the year	965,241	946,249	533,748
Cash and cash equivalents at end of the year	$ 1,499,116	$ 965,241	$ 946,249