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Equity method investment Equity method investment - Financial Position and Results of Operations (Details) - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019
Schedule of Equity Method Investments [Line Items] |  |  |
Assets | $ 38,469,399 | $ 34,932,860 |
Liabilities | 33,158,792 | 30,028,249 |
Total liabilities and stockholders' equity | 38,469,399 | 34,932,860 |
Bankers Healthcare Group, LLC |  |  |
Schedule of Equity Method Investments [Line Items] |  |  |
Assets | 2,724,542 | 1,330,317 |
Liabilities | 2,355,256 | 1,088,135 |
Equity interests | 369,286 | 242,182 |
Total liabilities and stockholders' equity | 2,724,542 | 1,330,317 |
Bankers Healthcare Group, LLC |  |  |
Schedule of Equity Method Investments [Line Items] |  |  |
Revenues | 735,506 | 457,928 | $ 366,500
Income before income taxes and equity in undistributed income of subsidiaries | $ 241,051 | $ 171,964 | $ 182,462

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