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Consolidated Statements of Cash Flows - USD ($)
$ in Millions
 9 Months Ended
Sep. 30, 2023
Sep. 30, 2022
Cash flows from operating activities:    
Net income $ 2,240 $ 1,784
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation and other amortization 1,093 982
Amortization of acquisition-related intangible assets 1,261 1,416
Amortization of financing costs and debt discounts 30 33
Share-based compensation 275 244
Deferred income taxes (344) (402)
Net (gain) loss on sale of businesses and other assets (172) (27)
Loss (income) from investments in unconsolidated affiliates 11 (222)
Distributions from unconsolidated affiliates 42 58
Other operating activities (2) (2)
Changes in assets and liabilities, net of effects from acquisitions and dispositions:    
Trade accounts receivable 119 (521)
Prepaid expenses and other assets (506) (203)
Contract costs (180) (230)
Accounts payable and other liabilities (303) 105
Contract liabilities 3 (30)
Net cash provided by operating activities 3,567 2,985
Cash flows from investing activities:    
Capital expenditures, including capitalized software and other intangibles (1,034) (1,148)
Net proceeds from sale of businesses and other assets 232 218
Payments for acquisition of businesses, net of cash acquired 0 (682)
Distributions from unconsolidated affiliates 110 110
Purchases of investments (15) (45)
Proceeds from sale of investments 0 13
Other investing activities (3) 0
Net cash used in investing activities (710) (1,534)
Cash flows from financing activities:    
Debt proceeds 5,188 1,450
Debt repayments (1,652) (2,945)
Net (repayments of) proceeds from commercial paper and short-term borrowings (2,032) 2,020
Payments of debt financing costs (38) 0
Proceeds from issuance of treasury stock 68 96
Purchases of treasury stock, including employee shares withheld for tax obligations (3,790) (1,909)
Settlement activity, net (630) 114
Distributions paid to noncontrolling interests and redeemable noncontrolling interests (22) (30)
Payment to acquire noncontrolling interest of consolidated subsidiary (56) 0
Payments of acquisition-related contingent consideration (33) 0
Other financing activities (39) 7
Net cash used in financing activities (3,036) (1,197)
Effect of exchange rate changes on cash and cash equivalents (8) (84)
Net change in cash and cash equivalents (187) 170
Cash and cash equivalents, beginning balance 3,192 3,205
Cash and cash equivalents, ending balance $ 3,005 $ 3,375