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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