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Income Tax Reconciliation of the tax provision at the U.S. Federal Statutory Rate (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Income Tax Contingency [Line Items]      
Tax provision at the U.S. federal statutory rate, Amount $ 4,685 $ 4,356 $ 3,776
Tax provision at the U.S. federal statutory rate, Percent 21.00% 21.00% 21.00%
State income taxes, net of federal benefit, Amount $ 419 $ 315 $ 271
State income taxes, net of federal benefit, Percent 1.90% 1.50% 1.50%
Share-based awards - excess tax benefit, Amount $ (100) $ (130) $ (132)
Share-based awards - excess tax benefit, Percent (0.40%) (0.60%) (0.70%)
Non-deductible compensation, Amount $ 144 $ 134 $ 119
Non-deductible compensation, Percent 0.60% 0.70% 0.70%
Health insurance industry tax, Amount $ 0 $ 626 $ 0
Health insurance industry tax, Percent 0.00% 3.00% 0.00%
Foreign rate differential, Amount $ (246) $ (164) $ (214)
Foreign rate differential, Percent (1.10%) (0.80%) (1.20%)
Other, net, Amount $ (324) $ (164) $ (78)
Other, net, Percent (1.50%) (0.80%) (0.50%)
Total provision for income taxes $ 4,578 $ 4,973 $ 3,742
Provision for income taxes, Percent 20.50% 24.00% 20.80%