Anecdotally, here's a lot more 'ancillary bloat' in academia now. You can't just buy a microscope, it has to go through a purchasing department. You can't buy your own conference tickets, there's a dedicated buyer. Money trickles down through multiple layers, each with their own beaurocracy. On top of your core science costs, you need to budget for public engagement etc. This has meant that there are more incremental studies being approved (that are closer to patient care), but fewer moonshots, which are harder to demonstrate outcomes.