The question is whether a madman administration might be able to do better. The only time that Pakistan has bent to Washington's will in any significant way was immediately after 9/11, when fear of a vengeful Washington led then-President Pervez Musharraf to cooperate on a variety of counterterror operations that netted top al Qaeda leaders on Pakistan's soil and to acquiesce, at least for several years, to an overthrow of Pakistan's favored Taliban regime in Afghanistan. As Musharraf has claimed in his memoir, he and other top Pakistani generals feared that unless they bowed to the Bush administration's demands, they would be "bombed back to the stone ages" or, more likely, would suffer the strategic consequences of seeing the United States align with India.
Perhaps Washington's problem in Pakistan has been the inability to muster a sufficiently credible threat (or perhaps a sufficiently generous inducement) to overwhelm Pakistan's other calculations about the costs and benefits of picking and choosing amid terror groups.