They're not perfect (nothing is), but they're actually pretty good. Every task has to be completable within a sprint. If it's not, you break it down until you have a part that you expect is. Everyone has to unanimously agree on how many points a particular story (task) is worth. The process of coming to unanimous agreement is the difficult part, and where the real value lies. Someone says "3 points", and someone points out they haven't thought about how it will require X, Y, and Z. Someone else says "40 points" and they're asked to explain and it turns out they misunderstood the feature entirely. After somewhere from 2 to 20 minutes, everyone has tried to think about all the gotchas and all the ways it might be done more easily, and you come up with an estimate. History tells you how many points you usually deliver per sprint, and after a few months the team usually gets pretty accurate to within +/- 10% or so, since underestimation on one story gets balanced by overestimation on another.
It's not magic. It prevents you from estimating things longer than a sprint, because it assumes that's impossible. But it does ensure that you're constantly delivering value at a steady pace, and that you revisit the cost/benefit tradeoff of each new piece of work at every sprint, so you're not blindsided by everything being 10x or 20x slower than expected after 3 or 6 months.