Efficient at what, exactly? Being enforced? Well, enforcement is on a voluntary basis, and supposedly stores have done well in that regard. At actually rating games? I can't really complain; of course there are games like Halo that are well above a T rating yet just below an M, but that's another issue entirely. I think the problem is similar to the one that led the to creation of the E 10+ rating. There's a fairly large gap between the T (13+) and M (17+) rating. There needs to be something like a T 15+ rating for games like Halo. But aside from that, I think the ESRB has done an admirable job so far. A lot of people might not remember, but there was a very real possibility that the U.S. government was going to put its paws in the industry back in the 90s, but the ESRB (and similar ratings like the ones Sega would put on their games before) prevented that.