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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, 2022
Dec. 31, 2021
Dec. 31, 2020
Income Tax Contingency [Line Items]      
Tax provision at the U.S. federal statutory rate, Amount $ 5,532 $ 4,685 $ 4,356
Tax provision at the U.S. federal statutory rate, Percent 21.00% 21.00% 21.00%
State income taxes, net of federal benefit, Amount $ 621 $ 419 $ 315
State income taxes, net of federal benefit, Percent 2.40% 1.90% 1.50%
Share-based awards - excess tax benefit, Amount $ (110) $ (100) $ (130)
Share-based awards - excess tax benefit, Percent (0.40%) (0.40%) (0.60%)
Non-deductible compensation, Amount $ 150 $ 144 $ 134
Non-deductible compensation, Percent 0.60% 0.60% 0.70%
Health insurance industry tax, Amount $ 0 $ 0 $ 626
Health insurance industry tax, Percent 0.00% 0.00% 3.00%
Foreign rate differential, Amount $ (265) $ (246) $ (164)
Foreign rate differential, Percent (1.00%) (1.10%) (0.80%)
Other, net, Amount $ (224) $ (324) $ (164)
Other, net, Percent (0.90%) (1.50%) (0.80%)
Total provision for income taxes $ 5,704 $ 4,578 $ 4,973
Provision for income taxes, Percent 21.70% 20.50% 24.00%