The US has to tolerate a lot of prevarication and half-vast efforts from the Pakis. We can't prosecute the war without them. Karachi is the SPOD for Central Asia, and just about every container that comes in here rides 800 miles in the back of a jingle truck, and the last part of that journey is through Pashtun tribal territory over which neither the Pakistani government nor the Raj ever exercised any effective control.
We can only squeeze Musharref so hard. His hold on power is tenuous, and his replacement will likely be worse. Assuming we could project the combat power into Pakistan to winkle Osama out of his cave, we will have invaded an "ally", causing Musharref's downfall and stranding CFC-A AND ISAF deep in Central Asia. Does anybody remember what happened to the Kabul garrison in the First Afghan War?