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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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Amount of assets that are expected to be realized or consumed within one year or the normal operating cycle, if longer, acquired at the acquisition date.

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Amount of other assets expected to be realized or consumed before one year or the normal operating cycle, if longer, acquired at the acquisition date.

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Amount recognized as of the acquisition date for the assets, including goodwill, in excess of (less than) the aggregate liabilities assumed, less the noncontrolling interest in the acquiree.

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