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Taxes Effective Tax Rate Reconciliation - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
Income Tax Disclosure [Abstract]      
Effective Tax Rate Reconciliation, Excess Tax Benefits $ (17,261) $ (28,279) $ (13,836)
Effect of Biotix contingent consideration gain 0 0 (4,394)
Income Tax Expense (Benefit), at Federal Statutory Income Tax Rate 157,236 143,092 136,890
State and Local Income Taxes 3,320 499 2,787
Deferred Tax Benefit, net related to Swiss Tax Reform 0 (15,833) 0
Provisional one-time charge on US tax reform 0 0 3,597
Foreign Income Tax Rate Differential 179 18,546 12,710
Other Adjustments 2,530 2,260 1,493
Provision for taxes $ 146,004 $ 120,285 $ 139,247
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate   21.00% 21.00%