Add a large pot of water to the stove over high heat.
Add oil to a large skillet with tall sides and heat over medium. Add the onion and cook until it begins to caramelize, about 5 minutes. Add the garlic, red pepper flakes, oregano, and basil; cook another minute.
Add your pasta to the boiling water. Cook until al dente, about 2-3 minutes less than the suggested amount of time on the packaging. Reserve at least 1-2 cups of pasta water. While the pasta cooks, continue making your sauce.
Add the tomato paste to the skillet and continue to cook for 3-4 minutes, stirring continuously. Pour in the vodka and let cook off for a 1-2 minutes. Reduce to medium-low heat and add the heavy cream, whisking to combine.
Once the pasta is al dente, transfer the pasta to the vodka sauce and add a ½ cup of pasta water. Mix together and let the pasta continue to cook in the sauce for about 3-5 minutes, adding more pasta water as needed to thin the sauce.
Mix in the butter and parmesan until melted.
Serve with fresh basil and extra parmesan!