The point of shoving the timestamp into it is to make it work well with database indexes. UUIDv4 is awful in that regard.
The issue with truly random IDs is that inserts are scattered throughout the B-tree index, which cause page splits, fragmentation, and poor cache locality. Using a timestamp prefix makes new IDs sequential, so inserts tend to land near the end of the index, which avoid all the B-tree trashing and improve write performance.