They only have consequences because enough people imbue the symbol with significance.
He can make state decisions (small state, but still).
Not comparable to strictly ceremonial function of Japan's emperor.
But decisions like the Roman Catholic Church's policy on contraception has only devastated as many lives as it has because those people choose to believe in the symbol.
The soldier aiming a gun at you or healthcare professional denying you access to contraception on the say-so of one of the above does have real power.
I'd love to see these sold. Their blemishes on a city that could use them for things like housing for our homeless/low income issues.