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CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2016
Sep. 30, 2015
Cash flows from operating activities:    
Net income $ 844,812 $ 392,936
Adjustments to reconcile net income to net cash provided by operating activities:    
Settlement charge   495,000
Settlement payments   (493,775)
Depreciation and amortization 531,475 474,694
Debt redemption charges   48,072
Goodwill impairment charges 253,000 4,065
Stock-based compensation expense 29,817 42,794
Tax benefits from stock award exercises 27,012 31,069
Excess tax benefits from stock award exercises (12,584) (19,555)
Deferred income taxes 48,778 (1,994)
Equity investment income, net 16,825 10,563
Gain on changes in ownership interests, net (404,165)  
Other non-cash charges 9,163 22,518
Changes in operating assets and liabilities, other than from acquisitions and divestitures:    
Accounts receivable (85,660) (178,148)
Inventories (13,045) (35,856)
Other receivables and other current assets (1,616) 54,924
Other long-term assets 31,081 1,940
Accounts payable (45,507) 11,473
Accrued compensation and benefits 79,289 123,081
Other current liabilities 119,549 96,671
Income taxes 65,164 35,282
Other long-term liabilities (12,126) 4,773
Net cash provided by operating activities 1,481,262 1,120,527
Cash flows from investing activities:    
Additions of property and equipment (575,243) (462,213)
Acquisitions (497,331) (90,709)
Proceeds from asset and business sales 18,991 6,865
Purchase of investments available for sale (9,041) (6,667)
Purchase of investments held-to-maturity (976,411) (1,555,604)
Proceeds from sale of investments available for sale 8,636 1,961
Proceeds from investments held-to-maturity 743,941 969,549
Purchase of intangible assets (75)  
Purchase of equity investments (11,629) (13,623)
Proceeds from sale of equity investments 40,920  
Distributions received on equity investments   57
Net cash used in investing activities (1,257,242) (1,150,384)
Cash flows from financing activities:    
Borrowings 39,102,302 41,371,392
Payments on long-term debt and other financing costs (39,201,016) (40,732,075)
Deferred financing and debt redemption costs (188) (59,354)
Purchase of treasury stock (620,898) (384,110)
Distributions to noncontrolling interests (145,072) (125,938)
Stock award exercises and other share issuances, net 18,515 19,802
Excess tax benefits from stock award exercises 12,584 19,555
Contributions from noncontrolling interests 35,524 28,212
Purchase of noncontrolling interests (9,727) (23,605)
Net cash (used in) provided by financing activities (807,976) 113,879
Effect of exchange rate changes on cash and cash equivalents (1,664) (1,844)
Net (decrease) increase in cash and cash equivalents (585,620) 82,178
Cash and cash equivalents at beginning of the year 1,499,116 965,241
Cash and cash equivalents at end of the period $ 913,496 $ 1,047,419