To answer in my usual, simple, plain-English way:
The answer is the former. If it was the latter, there would be no advantage to using the higher voltage. Ultimately, we care about how much power we can receive.
For a given current, you can get twice as much power at 240v as you can at 120v. Or, at 240v, we only need half as much current to deliver the same amount of power.
If you need to supply 200a worth of 120v loads, you could either supply them with 200a at 120v, or with 100a at 120/240v. Plus, you can serve 240v loads.
Those 240v loads could be built as 120v loads, but the supply circuits would have to have twice the ampacity, and the equipment itself would require beefier components.
It's basically a toss-up between safety and economics. Insulation is cheaper than conductor, so higher voltage can be more economical, but it's also more dangerous.