To be fair, the decision of when to make the final throw in a game is based on reading the clock before the throw while for most of the game there's nothing particularly interesting happening when the clock runs out.
Those earlier decisions matter just as much as the ones at the end. The fact that they are to some degree contingent decisions does not change the fact that early decisions have just as much impact as later ones. A basket scored 20 seconds into the game counts just the same as one scored at the end of the game.
The exact instant the clock is started generally has no bearing on win/loss or even goal/no goal.
The exact instance the clock is started has a VERY direct bearing on when it stops and as such it can have a bearing on the outcome in a close game.