I see hundreds of thousands of billable hours of mechanical turk and dungeon grade Indian and Chinese IT Services time spent +1ing SEO spam farm links.
And people do see who +1d something, it requires a public account - it's visible on the link (as displayed in the video, and implied by the same behavior with tweeted links) and on your profile page.
If a nobody from nowhere +1s a link, their friends will see it, but it's unlikely to affect the world at-large. Similarly, trust-metric wise, if a cluster of nobodies +1s a thousand pages, the impact will be restricted to their cluster. If an extremely-highly-connected person, who many people follow on Twitter / Reader / etc, +1s something, it'll have more impact simply by being visible to more people and because their "importance" can be inferred by those connections.