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Condensed Consolidated Statements of Cash Flows - USD ($)
$ in Millions
 6 Months Ended
Jun. 30, 2021
Jun. 30, 2020
Cash flows from operating activities:    
Net income $ 3,244 $ 1,914
Increase (decrease) in cash from operating assets and liabilities:    
Accounts receivable (567) 1,215
Inventories and other assets (213) (57)
Accounts payable and accrued expenses 49 (336)
Contract liabilities-deferred revenues 0 4,999
Depreciation and amortization 1,409 1,365
Income taxes 2 472
Losses (gains) on sales of facilities (10) 20
Losses on retirement of debt 12 295
Amortization of debt issuance costs and discounts 14 14
Share-based compensation 226 148
Other 73 49
Net cash provided by operating activities 4,239 10,098
Cash flows from investing activities:    
Purchase of property and equipment (1,496) (1,598)
Acquisition of hospitals and health care entities (98) (346)
Sales of hospitals and health care entities 30 39
Change in investments (12) (11)
Other 7 (37)
Net cash used in investing activities (1,569) (1,953)
Cash flows from financing activities:    
Issuances of long-term debt 4,337 2,700
Net change in revolving credit facilities 800 (2,480)
Repayment of long-term debt (3,731) (3,364)
Distributions to noncontrolling interests (357) (199)
Payment of debt issuance costs (32) (35)
Payment of dividends (325) (153)
Repurchase of common stock (3,814) (441)
Other (224) (144)
Net cash used in financing activities (3,346) (4,116)
Effect of exchange rate changes on cash and cash equivalents 3 (12)
Change in cash and cash equivalents (673) 4,017
Cash and cash equivalents at beginning of period 1,793 621
Cash and cash equivalents at end of period 1,120 4,638
Interest payments 755 854
Income tax payments (refunds), net $ 844 $ (16)