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Taxes Effective Tax Rate Reconciliation (Details) - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2019 | Dec. 31, 2018 | Dec. 31, 2017
Income Tax Disclosure [Abstract] |  |  |
Effective Tax Rate Reconciliation, Excess Tax Benefits | $ (28,279) | $ (13,836) | $ (35,171)
Effect of Biotix contingent consideration gain | 0 | (4,394) | 0
Income Tax Expense (Benefit), at Federal Statutory Income Tax Rate | 143,092 | 136,890 | 200,978
State and Local Income Taxes | 499 | 2,787 | 376
Deferred Tax Benefit, net related to Swiss Tax Reform | (15,833) | 0 | 0
Provisional one-time charge on US tax reform | 0 | 3,597 | 71,982
Foreign Income Tax Rate Differential | 18,546 | 12,710 | (43,691)
Other Adjustments | 2,260 | 1,493 | 3,776
Provision for taxes | $ 120,285 | $ 139,247 | $ 198,250
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent |  | 35.00% | 35.00%

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- Definition The net benefit recorded to the income statement related to the enactment of Swiss Tax Reform. The amount primarily related to deferred benefits associated with an allowed step-up of intangible assets for tax purposes. + References No definition available. + Details
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