Sure they matter in the grand scheme of things. While it's true that they're not exactly 100% legitimate championships, given that pro wrestling is staged, the titles are generally supposed to be a symbol of standing within the company. They represent glory and are proof of one's ability to get the job done.
In a lot of situations, however, the value of championships do fluctuate. At one point or another, probably all of us have griped about how titles are used. Sometimes it's justified. Like right now, for instance, both the mid-card titles in both WWE and TNA don't exactly count for a lot. WWE's mid-card titles seem to have peaks and valleys. For instance, during the past few months, the mid-card championships and the wrestlers holding them have been pretty much buried. Neither Wade Barrett nor Antonio Cesaro, two wrestlers with a lot of talent and hard workers, didn't have a spot on the main WM card. Barrett's IC title match was pushed to the pre-show and Cesaro didn't have any involvement whatsoever. After a strong IC title match on Raw this past Monday, here's hoping that WWE will start to bringing the title back to prominence as it heads into the post WrestleMania season. As for the US title, it's all up in the air. It's generally thought of as being less prestigious than the IC title, at least in terms of how it's treated overall in WWE. In TNA, both mid-card titles have generally gone for years as being little more than belts that certain wrestlers simply hold onto for a while before the company decides to let another wrestler carry it. The exception for the X Division being Austin Aries, but the title went back to the status quo after he dropped it. As for the TV title, it's never really meant anything in its existence. It often goes for months on end without being defended.
In WWE, the tag team titles have meant more in the past 7 months than they have in the past 5 years. Like the mid-card titles, the tag team picture, which had been doing pretty well all in all, was put on the backburner during WrestleMania season. Now that it's over, here's hoping that things get back on track. While the charm of the unique comedic chemistry between Bryan & Kane has worn off quite a bit, they're still two talented wrestlers that are extremely over, especially Bryan, with fans. It's starting to look like Team Hell No might be embarking on some sort of tag team feud with The Shield, so that's something to look forward to and will put a good deal more emphasis on the tag titles as a whole than in the past few months.
As far as the World Championships in WWE, the WWE Championship is almost always treated like the top tier championship that it is. There are always going to be complaints about everything from how the title looks to who is getting a run with it to what order WWE Championship matches should place on the card, etc. Generally speaking, at least most of the time, that's just nitpicking. The title has gotten a big dose of renewed interest since CM Punk became champion and held the title for longer than anyone else in the past quarter century.
The World Heavyweight Championship will always be secondary to the WWE Championship. Because of that, a lot of people have questioned the need to have a second World Championship. The primary reason, I think, has a lot to do with house shows. Initially, it was part of keeping Raw & SmackDown! as two separate brands with their own top champions. However, that's pretty much disappeared with the separate World Championships being one of the last real remnants of brand exclusivity in WWE. That's not to say that there haven't been some great champions, especially in the past year and a half or so. Mark Henry, Daniel Bryan, Sheamus, Big Show and even Alberto Del Rio had strong heel & babyface runs with the title. Some reigns were more enjoyable and interesting than others, which that's to be expected with any championship in any sport regardless.
If you treat titles like they don't matter, then I believe it hurts the product in some ways. During the late 90s and early 2000s especially, championships in major wrestling companies probably meant less than they ever have before or since. It wasn't at all uncommon for titles to change hands more than once a month, especially in WCW. If you treat titles like meaningless props, that's how fans will view them. Championships are a logical focal point of top wrestling feuds because of what the titles are supposed to represent, namely greater personal prestige, fame and wealth.
