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He was first elected to the Legislative Assembly of Saskatchewan in the 1967 provincial election. From 1971 to 1982, he served as deputy premier of Saskatchewan. From 1987 to 2001, he was leader of the Saskatchewan New Democratic Party.
During the 1981 discussions over the repatriation of the Canadian constitution, these three men worked out most of Canada's new constitution at the famous late night "kitchen table discussion". Romanow helped push the constitution to the left: he objected strongly to any protections on private property in the new Charter of Rights and Freedoms, and none were included.
Romanow's government was more conservative than previous NDP administrations, and was considered a practitioner of what became known as the Third Way in the mould of the British Labour Party under Tony Blair. The Romanow government eliminated the budgetary deficit it inherited from the Progressive Conservative government of Grant Devine by closing hospitals and cutting services.
In the 1999 provincial election, the NDP was re-elected to a third consecutive term but was reduced to a minority of seats in the legislature. Romanow negotiated an agreement to form a coalition government with the Saskatchewan Liberal Party, appointing several Liberals to Cabinet. Romanow retired in 2001, and was replaced as leader of the NDP and Premier by Lorne Calvert.
The federal Liberals, and especially Jean Chrétien, had long tried to encourage Romanow to run federally as a Liberal, but he always refused.
On April 4, 2001, Romanow was appointed to head the Commission on the Future of Health Care in Canada by Prime Minister Jean Chrétien. He released the Romanow Report in 2002, which outlined suggestions to improve the health care system.
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