One-Pot Meatballs & Pasta

Divide the sausage into 32 portions and roll each one into a tablespoon-sized meatball.
In a Dutch oven, melt 2 tablespoons of butter over medium-high heat. Cook, stirring frequently until the meatballs are browned all over (3 minutes per side). It's possible that the meatballs aren't fully cooked at this time. Place on a plate to cool.
Melt the remaining 1 tablespoon of butter in the pan over medium-high heat. Add the onion, salt, and pepper, and cook, scraping up any browned pieces from the bottom of the pan (5 minutes or until the onion softens). Stir in the garlic, and tomato paste. Pour in 2 cups of water or broth, vinegar, sugar, and oregano. Combine the spaghetti and meatballs, as well as any fluids that have gathered on the dish. Bring to a boil.
Reduce the heat to medium-low and simmer, turning often, for 25 to 30 minutes, or until the pasta is slightly done and the meatballs are cooked through. If you prefer a soupier consistency, add more water or broth as needed. If preferred, add Parmesan cheese and red pepper flakes when serving.