If you have an insurance pink slip in North America, the liability coverage from your own car insurance will extend as "secondary" coverage for any vehicle you drive in North America (not Mexico or Europe).
Many US states (including, I believe, California, Nevada, and Hawaii) do not require rental car companies to carry liability insurance. If you rent a car in one of those states, and do not have a pink slip for your own car, you are essentially an uninsured driver and will be personally responsible for any liability/injury claims against you.
It's also a really good idea to keep a copy of your pink slip in your wallet. (I recently avoided a "driving without proof of insurance" ticket when driving some one else's car by showing my own pink slip).
Credit card coverage is for damage to the vehicle only, and actually works pretty well for that. You have to make sure to pay for the car with the card, though.
If you don't own a car, you can get liability insurance that will cover you, or you can pay for the "SLI" at the rental car counter.
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