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1. Significant Accounting Policies Property, Plant and Equipment (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016	Jan. 01, 2018
Property, Plant and Equipment [Line Items]
Restricted investments	$ 5,560	$ 5,560
Retained earnings	3,722,073	1,830,439
Other assets	70,298	94,949
Prepaid Taxes	5,500			$ 22,800
Equipment	970,081	971,140
Deferred income taxes	553,239	222,209
Income Tax Expense (Benefit)	$ (147,045)	$ 24,444	$ (15,560)
Minimum [Member] \| Software [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Useful Life	3 years
Minimum [Member] \| Building and Building Improvements [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Useful Life	15 years
Minimum [Member] \| Reagent Rental Equipment [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Useful Life	1 year
Minimum [Member] \| Equipment [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Useful Life	3 years
Maximum [Member] \| Software [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Useful Life	12 years
Maximum [Member] \| Building and Building Improvements [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Useful Life	39 years
Maximum [Member] \| Reagent Rental Equipment [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Useful Life	5 years
Maximum [Member] \| Equipment [Member]
Property, Plant and Equipment [Line Items]
Property, Plant and Equipment, Useful Life	12 years
Adjustments for New Accounting Pronouncement [Member]
Property, Plant and Equipment [Line Items]
Retained earnings				$ 1,543,700