This is a story about the complete failure of self-regulation... again... self-regulation does not work when the regulation necessary is in direct conflict with the purpose of the people who are supposed to be regulating themselves... US businesses exist to make money and only make money (understanding that anything else is maybe something they should pay attention to is an anthema to them - businesses in many other countries might have money as their primary motive but many also include community, society and other non-money related motives as secondary motives, more similar to non-profits and (a few) religions in the US).
The ESA and ESRB are basically trash and nothing will be done by them until they are forced to by the government, especially in the US where the worship of mammon by the business world and beyond is paramount and to consider anything else is tantamount to heresy ... consider the continued opposition by a lot of people to Elon Musk (someone who is clearly spending a lot of money for the gain of much less money in an attempt to advance technology rather than follow the "all-powerful" dollar).
If games publishers refuse to adapt to markets outside the US then they will crash and burn when the EU bans loot boxes and similar mechanics (potentially retroactively), nevermind the other countries that would likely follow-suit if such a large trading bloc were to make such a move. And the way this will happen is politicians actually paying attention to the gambling in NBA 2K20 which is so blatantly in breach of the law as to be the equivalent of having a game in which you hack the Pentagon's computers where the game _actually_ hacks the Pentagon's computers...
@Hammlet Certainly US-style ultra-capitalism... it kinda works with European-style or Chinese-style capitalism but then neither are so much self-regulation in its purist form...