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Leases - Lease cost (Details) - USD ($) $ in Thousands | 12 Months Ended
--- | ---
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018
Leases [Abstract] |  |  |
Facility operating expense | $ 19,241 | $ 18,677 |
Facility lease expense | 224,033 | 269,666 | $ 303,294
Operating lease expense | 243,274 | 288,343 |
Operating lease expense adjustment | 136,276 | 19,453 |
Changes in operating lease assets and liabilities for lessor capital expenditure reimbursements | (22,242) | (31,305) |
Operating cash flows from operating leases | 357,308 | 276,491 |
Payments for lease restructuring | 119,200 |  |
Depreciation and amortization | 32,647 | 46,646 |
Interest expense: financing lease obligations | 48,534 | 66,353 | $ 83,604
Financing lease expense | 81,181 | 112,999 |
Operating cash flows from financing leases | 48,534 | 66,353 |
Financing cash flows from financing leases | 18,867 | 22,242 |
Changes in financing lease assets and liabilities for lessor capital expenditure reimbursement | (5,603) | (3,504) |
Total cash flows from financing leases | $ 61,798 | $ 85,091 |

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- Definition Amount of interest expense on finance lease liability. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 842 -SubTopic 20 -Section 50 -Paragraph 4 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=121609121&loc=SL77918686-209980 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 842 -SubTopic 20 -Section 45 -Paragraph 4 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=121603541&loc=SL77918638-209977 Reference 3: http://www.xbrl.org/2003/role/exampleRef -Publisher FASB -Name Accounting Standards Codification -Topic 842 -SubTopic 20 -Section 55 -Paragraph 53 -URI http://asc.fasb.org/extlink&oid=121568110&loc=SL77918982-209971 + Details
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