Healy is the country's runaway record goalscorer with 36 in 94 caps and although he is still in the national set-up, his days as a starter are over.
Yet neither O'Neill nor predecessor Nigel Worthington have been able to call on someone who has been able to regularly replicate Healy's eye for goal.
Indeed, it was Healy who stepped up from the bench to hit an injury-time equaliser against Azerbaijan in the side's last World Cup qualifier.
Burnley forward Paterson is likely to get the nod when the campaign gets back under way against Israel on Tuesday night - provided the snow that led to the Russia fixture being postponed on Friday and Saturday does not return.
And, after ending a brief self-imposed international exile while he worked on his fitness, he has set his sights high.
"I always think if I do get chances to play regularly up the middle I will score goals, take up David Healy's mantle," he said.
"To step into his shoes is something very difficult to do but something I would love to do and something I will work very hard to do.
"I would love to do that."
Paterson, 25, scored his first international goal from the penalty spot in his 14th appearance against Finland last August and has not played since.
After struggling with thigh and hamstring problems that were disrupting his club career, he informed O'Neill that he did not wish to be considered for Northern Ireland until he could be confident he was fully fit.
That meant he missed the memorable 1-1 draw in Portugal, as well as four other matches, but he is back and desperate to prove his commitment now.
"It was a tough decision, because every footballer has a young boy in him who just wants to play all the time," he explained.
"To make a decision not to play benefited me in terms of staying fit but watching fantastic performances from the sidelines hurt.
"That hurt can drive you on, though.
"Obviously I am older now, free of injury and this step in my career is the most important.
"I'm 25 years old and fully fit. This campaign and the next year in terms of club football will be the best I have; I am ready to explode. "I definitely have a point to prove and I want to make up for lost time.
"The decision not to play for a couple of (international) games was a decision to play 20 games or more at my club, not struggle through games or come in at 80% fitness. I'm at at 100% now."
The double cancellation of the Russia fixture created huge amounts of frustration among Northern Ireland fans, with some questioning the Irish FA's decision not to bring in covers to help battle the elements.
The players have been spending large amounts of additional time in their Belfast hotel as a result, but despite the disruption Paterson believes his side will be fully prepared for the visit of Israel.
"It is hard when you have a game cancelled, you build yourself up and then wait around for decisions, but we have still been training," he said.
"We're disappointed it wasn't on but we've regrouped and concentrated on Israel.
"I'm feeling excellent personally and physically I'm in the best shape of career so I'm looking to kick on. It's a massive game for me personally."
There has been one change to O'Neill's squad for the match, with Rangers man Andy Little ruled out with a knee complaint and Hull's Corry Evans joining the squad.
Evans missed out on the initial get together due to a quad complaint but passed a fitness test and trained with the side.