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Equity method investment - Financial Position and Results of Operations (Details) - USD ($)
$ in Thousands
 3 Months Ended 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Dec. 31, 2019
Schedule of Equity Method Investments [Line Items]          
Assets $ 33,342,112   $ 33,342,112   $ 27,805,496
Liabilities 28,646,465   28,646,465   23,449,748
Liabilities and Equity 33,342,112   33,342,112   27,805,496
Bankers Healthcare Group, LLC          
Schedule of Equity Method Investments [Line Items]          
Assets 1,268,208   1,268,208   840,398
Liabilities 1,046,948   1,046,948   641,037
Stockholders' Equity, Including Portion Attributable to Noncontrolling Interest 221,260   221,260   199,361
Liabilities and Equity 1,268,208   1,268,208   $ 840,398
Revenues 92,790 $ 107,982 190,734 $ 170,799  
Income (Loss) from Continuing Operations, Net of Tax, Including Portion Attributable to Noncontrolling Interest $ 37,674 $ 67,564 $ 70,145 $ 94,699