There are 2 champions with %hp true damage(unless you consider botrk+conqueror as such): Fiora and Vayne
Vayne's true damage is actually counterable(a bit) by getting an item with AS slow:
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. And, unless you have a lot of armor and hp, her AA damage matters more than her W
Fiora's mobility allows her to dash through the fight to reach squishy targets, while her healing on ult requires her team to kill ulted target first, but she has to ult a tank to maximise her true damage potential. This makes it a difficult choice sometimes for the Fiora player. Without % true damage her only working tactic would be diving to enemy adc and ulting him.
Also, there is a reason for adding things like true damage/%armor pen/%hp damage. It is to make sure champion can deal well against tanks while not oneshotting everyone else.
With just normal damage, to kill a tank with 200 armor and 4000 hp in 10 seconds, you need to have 1200 dps. Squishies with 2000 hp and 50 armor will die in 2 seconds to this kind of damage
But if for some reason you could do 50% of your damage as true, you would need only 600 dps to kill the same tank in same time. With this damage you will kill squishies for almost twice as long. Looks much more balanced for me
Same logic applies to other anti-tank stuff. It allows people to kill tanks in reasonable time without kiling non-tanks in unreasonably low time.