Trim is a tool. The "default" position should be horizontal, but there are times when it is fine not to be in that position -- for example, if you are drifting along a vertical wall, there's no particular reason to be perfectly horizontal (although if you aren't, it will be hard to back up if the water begins to push you into the coral!)
People have already mentioned both reducing the effort of swimming forward by presenting the smallest cross-sectional area to the water, and also not disturbing bottom sediments and reducing the vis. But there is another, more subtle and pernicious problem with being out of trim.
If you are swimming with your head up 45 degrees and you kick, where is your kicking pushing you? Forward . . . and UP. Each kick wants to push you shallower in the water column. So, in order to remain at the depth you want, what do you have to do? You have to produce a force downward that counters that force upward from your fins -- and you do that by remaining negative, so that if you stop swimming, you will sink. That leads to two things -- one, a significant part of your kicking effort is expended just to remain where you ARE; that's all breathing gas you used to achieve a net of nothing. Second, because you are not neutral, you CANNOT stop -- if you stop, you will sink. That makes inspecting small animals or getting good photographs very difficult, and in some cases, can lead to a great deal of anxiety on the part of the diver, who feels like he is sinking all the time. (Note that the exact same arguments apply if you are feet-up, as some wetsuit divers are, except that you have to stay positive instead of negative, but you still can't stop.)
Being able to stay horizontal and STILL is one of the core competencies of diving. Once you have a stable, flat platform, you can perturb it at will, knowing what you are doing and what the effects are going to be. But until you have that platform, you are constantly correcting some kind of instability, and it limits what you can do.