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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2016
Dec. 31, 2015
Dec. 31, 2014
Cash flows from operating activities:      
Net income $ 1,033,082 $ 427,410 $ 863,330
Adjustments to reconcile net income to net cash provided by operating activities:      
Settlement charge and loss contingency accrual   495,000 17,000
Depreciation and amortization 720,252 638,024 590,935
Goodwill and other asset impairment charges 296,408 210,234  
Debt redemption and refinancing charges   48,072 97,548
Stock-based compensation expense 38,338 56,664 56,743
Tax benefits from stock award exercises 28,397 45,749 59,119
Excess tax benefits from stock award exercises (13,251) (28,157) (45,271)
Deferred income taxes 52,010 61,744 210,955
Equity investment income, net 17,766 9,293 10,125
Gain on sales of business interests, net (404,165)    
Other non-cash charges, net (7,338) 44,691 39,274
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures:      
Accounts receivable (152,240) (202,867) (40,676)
Inventories 22,920 (48,313) (46,398)
Other receivables and other current assets (54,038) 32,761 (61,674)
Other long-term assets 35,893 3,723 2,916
Accounts payable 11,897 30,998 (2,956)
Accrued compensation and benefits 68,272 54,950 97,261
Other current liabilities 176,494 113,470 83,590
Settlement payments   (493,775) (410,356)
Income taxes 62,230 24,175 (60,475)
Other long-term liabilities 30,517 33,354 (1,583)
Net cash provided by operating activities 1,963,444 1,557,200 1,459,407
Cash flows from investing activities:      
Additions of property and equipment (829,095) (707,998) (641,330)
Acquisitions (563,856) (96,469) (272,094)
Proceeds from asset and business sales 64,725 19,715 8,791
Purchase of investments available-for-sale (13,539) (8,783) (8,440)
Purchase of investments held-to-maturity (1,133,192) (1,709,883) (472,628)
Proceeds from sale of investments available-for-sale 18,963 2,058 2,475
Proceeds from investments held-to-maturity 1,240,502 1,637,358 141,072
Purchase of intangible assets     (1,018)
Purchase of equity investments (27,096) (17,911) (35,382)
Proceeds from sale of equity investments 40,920    
Distributions received on equity investments   129 825
Net cash used in investing activities (1,201,668) (881,784) (1,277,729)
Cash flows from financing activities:      
Borrowings 51,991,490 54,541,988 60,038,508
Payments on long-term debt and other financing costs (52,115,932) (53,922,290) (60,046,487)
Deferred financing and debt redemption and refinancing costs (188) (76,672) (122,988)
Purchase of treasury stock (1,097,822) (549,935)  
Distributions to noncontrolling interests (192,401) (174,635) (149,339)
Stock award exercises and other share issuances, net 23,543 26,155 19,500
Excess tax benefits from stock award exercises 13,251 28,157 45,271
Contributions from noncontrolling interests 47,590 54,644 64,655
Proceeds from sales of additional noncontrolling interests     3,777
Purchases of noncontrolling interests (21,512) (66,382) (17,876)
Net cash used in financing activities (1,351,981) (138,970) (164,979)
Effect of exchange rate changes on cash and cash equivalents 4,276 (2,571) 2,293
Net (decrease) increase in cash and cash equivalents (585,929) 533,875 18,992
Cash and cash equivalents at beginning of the year 1,499,116 965,241 946,249
Cash and cash equivalents at end of the year $ 913,187 $ 1,499,116 $ 965,241