In a Dutch oven, cook ground beef and onion over medium-high heat until the meat is no longer pink and the onion is translucent, about 5-7 minutes. Stir in the garlic and cook for 30 seconds. Drain off any excess grease.
Stir in tomatoes, Italian seasoning, salt, and sugar. Reduce heat to medium-low and simmer gently, stirring occasionally, for 10 minutes.
Add the pasta and water. Increase the heat to medium-high and cook, stirring often, until the pasta is tender, about 16-18 minutes.
Taste and season with additional salt and pepper, if desired.
Serve immediately and garnish with chopped fresh basil (or other herbs), crushed red pepper flakes, and Parmesan cheese, if desired.