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Acquisitions and Divestitures Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands | Sep. 30, 2021 | Dec. 31, 2020 | Dec. 31, 2019
--- | --- | --- | ---
Business Acquisition [Line Items] |  |  |
Goodwill | $ 6,940,667 | $ 6,919,109 | $ 6,787,635
Dialysis and other businesses |  |  |
Business Acquisition [Line Items] |  |  |
Current assets | 5,655 |  |
Property and equipment | 4,154 |  |
Noncompetition agreements and other long-term assets | 4,451 |  |
Indefinite-lived licenses | 2,448 |  |
Goodwill | 53,619 |  |
Liabilities assumed | (9,456) |  |
Noncontrolling interests | (3,921) |  |
Total assets acquired and liabilities assumed | $ 56,950 |  |

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